Senior Psychiatric Case Manager | Utilization & Denials

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

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.