Pediatric Behavioral Health UM Case Manager

20 Driscoll Children's Health Plan; Corpus Christi (TX); Presencial; USD 75.000 - 100.000; Jornada completa

Descripción de la vacante

Driscoll Health System in Texas seeks an experienced Utilization Management Case Manager to coordinate care and ensure clinically appropriate, fiscally responsible services across the continuum. The role collaborates with physicians, health plan directors, and care teams to assess patient needs and determine level of care.

Responsibilities include prospective, concurrent, and retrospective reviews, applying plan benefits consistently, identifying members for disease management, and coordinating

Formación

• Graduate of an accredited school of Registered Nursing or Licensed Clinical Social Work (LCSW).
• A minimum of three (3) years of prior clinical experience.
• One year of acute inpatient case management or managed care case/utilization management experience is preferred.

Responsabilidades

• Participate in timely, quality completion of preauthorization or case management activities.
• Apply plan benefits consistently for each line of business.
• Identify members with health care needs for possible disease management programs available within the plan.
• Coordinate services with community resources.
• Report suspected or actual quality concerns, provider, eligibility, and compliance issues per policy.
• Collaborate with physicians, social workers, Case Managers, and other multidisciplinary team members to obtain optimal outcomes for members.
• Collaborate with hospital case managers to ensure safe discharge and patient safety.
• Complete concurrent and/or retrospective review for appropriateness of hospital treatment using plan-approved criteria.

Conocimientos

Time management

Customer relations

Microsoft Office

Medical management software

InterQual

Medicaid criteria

Managed care contracts

Communication skills

Educación

Registered Nurse (RN)

Licensed Clinical Social Worker (LCSW)

Herramientas

InterQual

Descripción del empleo

Driscoll Health System in Texas seeks an experienced Utilization Management Case Manager to coordinate care and ensure clinically appropriate, fiscally responsible services across the continuum. The role collaborates with physicians, health plan directors, and care teams to assess patient needs and determine level of care.

Responsibilities include prospective, concurrent, and retrospective reviews, applying plan benefits consistently, identifying members for disease management, and coordinating