PRN Utilization Review Coordinator — Case Management

The Menninger Clinic; Houston (TX); Presencial; USD 55.000 - 83.000; Jornada completa

Descripción de la vacante

The Menninger Clinic in Houston, TX is seeking a PRN Utilization Management professional with a Master’s degree and licensure in a clinical discipline. The role involves reviewing records, coordinating with Admissions, and performing utilization reviews for insurance payers.

Responsibilities include educating teams about discharge options, preparing for regulatory surveys, and maintaining ethical, thorough documentation. Local travel is not required; shifts are Mon-Fri 8:00am–5:00pm as needed.

Formación

• Master's degree in a clinical discipline and licensure.
• Three years of healthcare experience.
• One year of full-time experience performing insurance reviews (pre-certification and/or concurrent).
• Proficient with computers, phones, fax machines, and basic office equipment.
• Basic knowledge of MS Office and health insurance regulations.

Responsabilidades

• Review internal and external records as part of daily department operations.
• Coordinate with Admissions to complete certifications and document outcomes.
• Perform concurrent utilization reviews with payers and document outcomes.
• Obtain and document authorization for services not covered and communicate with physicians.
• Maintain ethical reviews for both internal and external cases.
• Develop relationships with treatment team to enhance Utilization Management.
• Communicate case status to team and physician; coordinate peer reviews as needed.
• Attend team meetings and educate teams/patients on discharge options and continuum of care.
• Assist in survey preparedness for regulators and payers.
• Audit charts; report deficits and ensure completeness before review completion.

Conocimientos

Computers

MS Office

Healthcare knowledge

Managed care concepts

Team concepts

Psychopathology

Educación

Master's degree in clinical discipline

LPC/LMSW/RN/LCSW licensure

Herramientas

Microsoft Office

Descripción del empleo

The Menninger Clinic in Houston, TX is seeking a PRN Utilization Management professional with a Master’s degree and licensure in a clinical discipline. The role involves reviewing records, coordinating with Admissions, and performing utilization reviews for insurance payers.

Responsibilities include educating teams about discharge options, preparing for regulatory surveys, and maintaining ethical, thorough documentation. Local travel is not required; shifts are Mon-Fri 8:00am–5:00pm as needed.