Senior Psychiatric Case Manager: Utilization & Appeals

Lake Charles Memorial Hospital; Lake Charles, Northern (LA, KY); Hybrid; USD 52,000 - 72,000; Full time

Job summary

Lake Charles Memorial Hospital seeks a Psychiatric Case Manager to supervise day-to-day department functions and staff, drive improvements and efficiency, and support patient care goals.

You will prepare notification letters, conduct utilization reviews, ensure regulatory compliance, review records, and manage pre-certs and denials with a focus on timely authorization and clinical accuracy. Strong leadership required.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Communication skills

Emotional stability

Leadership

Adaptability

Education

Bachelor's degree in Social Work or Nursing

3-5 years experience with mentally ill or addictions

Louisiana Nursing License or multi-state compact nursing license

Crisis Response Training, CPR

Job description

Lake Charles Memorial Hospital seeks a Psychiatric Case Manager to supervise day-to-day department functions and staff, drive improvements and efficiency, and support patient care goals.

You will prepare notification letters, conduct utilization reviews, ensure regulatory compliance, review records, and manage pre-certs and denials with a focus on timely authorization and clinical accuracy. Strong leadership required.