Psychiatric Case Manager

Lake Charles Memorial Hospital; Lake Charles (LA); On-site; USD 60,000 - 90,000; Full time

Job summary

Lake Charles Memorial Hospital is seeking a Psychiatric Case Manager to oversee daily department operations and drive improvements in denial reductions and efficiency. The role reports to the Director of Psychiatric Services and requires strong leadership and collaboration with medical staff.

The incumbent will perform utilization reviews, reviews of patient records and treatment plans, and manage denials appeals.

Qualifications

• BA or RN with Social Work or Nursing Certification required/preferred.
• 3–5 years minimum experience with mental illness and/or addictions.

Responsibilities

• Prepares information for notification letters for providers and employees.
• Performs utilization review per state regulations.
• Maintains compliance with regulation changes affecting utilization management.
• Performs continuing review on medical records and identifies ongoing hospitalization needs.
• Reviews patient records and evaluates progress.
• Obtains and reviews medical reports and treatment plan requests for reviews.
• Reviews and validates physician orders, reports progress and unusual occurrences.
• Receives and processes requests for denials appeals.
• Attends meetings regarding approvals, denials, pre-certs, authorizations and retro reviews.

Skills

Communication

Leadership

Organizational skills

Emotional stability

Decisiveness

Education

BA or RN with Social Work preferred

Louisiana Nursing License or multi-state license preferred

Crisis Response Training

CPR training

Job description

DESCRIPTION OF POSITION:

• The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.

SUPERVISION: Reports directly to Director of Psychiatric Services

RESPONSIBILITIES AND DUTIES:

• Prepares information for notification letters for providers and employees.
• Performs utilization review in accordance with all state mandated regulations.
• Maintains compliance with regulation changes affecting utilization management.
• Performs continuing review on medical records and identification and need of on-going hospitalization.
• Reviews patients' records and evaluates patient progress.
• Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review.
• Reviews and validates physician's orders, reports progress and unusual occurrences on patients.
• Receives & processes requests for appeal of denials.
• Attends required meetings regarding approvals, denials, pre-certs, authorizations and retro reviews.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• BA required, Social Work preferred OR Nursing Certification with RN preferred
• Minimal 3-5 Years Experience working with mentally ill &/or addictions required
• Louisiana Nursing License or multi-state compact nursing license preferred, Crisis Response Training, CPR
• Ability to communicate with patient, family, peers and medical personnel.
• Requires emotional stability and resilience.
• Must be adaptable to change, be decisive, and demonstrate foresight.
• Exhibits organizational and leadership ability.
• Shows ability to gain and maintain support and respect.

Physical Demands/Work Environment

• Work requires a variety of physical activities including sitting, standing and walking.
• Bending, stooping, and lifting are minimal.
• The work environment may be physically confining.
• Visual acuity required for a variety of activities.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

"Experience Memorial" is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well‑being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

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