UR Case Manager

Alvarado Parkway Institute Behavioral Health System; La Mesa (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Alvarado Parkway Institute in La Mesa, California is seeking a qualified UR Case Manager to monitor and ensure appropriate allocation of hospital resources within a busy psychiatric setting.

The UR/CM team collaborates with treatment staff to ensure regulatory-compliant documentation, while communicating effectively with payers. Strong organization, multitasking, and stress management are essential.

Qualifications

• High school graduate with strong reading, writing, and math skills.
• Knowledge of health care service delivery systems and third-party reimbursement.
• Understanding of admission and discharge function.
• Familiarity with medical terminology, diagnostic terms and treatment modalities.
• Knowledge of medical record keeping.
• Strong interpersonal, organizational, evaluative, and time management skills.
• Policy interpretation skills.
• Familiarity with applicable standards and regulations.
• Able to comprehend psychiatric evaluations, consults, lab results, etc.
• Flexibility and attention to detail.
• Ability to work with minimal direction or supervision.

Responsibilities

• Conducts concurrent and extended stay reviews.
• Prepares and submits appeals to 3rd party payers.
• Maintains appropriate records of the Utilization Review Department.
• Participates in activities which enhance professional growth and development.
• Other duties as assigned.

Skills

Telephone skills

Verbal communication

Healthcare knowledge

Medical terminology

Medical records

Interpersonal skills

Organizational skills

Time management

Policy interpretation

Regulatory knowledge

Multitasking

Attention to detail

Stress management

Assertiveness

Self-direction

Education

RN/LVN license or Master’s in behavioral health

Job description

Description

Are you interested in working in a fast-paced, challenging behavioral healthcare organization? Are you interested in a position that is rewarding and makes a difference in the lives of others? Do you like to be challenged and work in a setting that allows you to grow? Then Alvarado Parkway Institute wants to hear from you!

Alvarado Parkway Institute (API) is a free-standing psychiatric hospital in La Mesa, California with three Intensive Outpatient/Partial Hospitalization Programs. Alvarado Parkway Institute (API) provides comprehensive adult inpatient behavioral health and addictive disorders services in a 66-bed hospital setting located in La Mesa, California. At Alvarado Parkway Institute, we are committed to improving the mental health and well-being of our community. Alvarado Parkway Institute in La Mesa is San Diego County's leading provider of comprehensive mental health and substance abuse care. API offers a variety of Outpatient Services designed to assist patients in functioning at the highest level. API provides Partial Hospitalization services and Intensive Outpatient services. These programs emphasize symptom management, community integration, and prevention of hospitalization or re-hospitalization. Value-added services enhance the patient’s treatment experience.

Alvarado Parkway Institute is currently seeking a qualified individual to join our team as a UR Case Manager. The UR Case Managers are responsible for monitoring and ensuring the appropriate allocation of hospital resources. The Utilization Review / Case Management (UR/CM) Department addresses appropriate utilization, over-utilization, under-utilization, and inefficient use of resources. UR Case Managers need to be knowledgeable about psychiatric symptoms, behaviors, and diagnoses. The UR/CM Department works closely with the treatment team and ensures that all documentation meets regulatory requirements. Strong communication and organizational skills are required. Must be able to multitask and function well under stress.

Requirements

UR Case Manager Responsibilities:

• Conducts concurrent and extended stay reviews
• Prepares and submits appeals to 3rd party payers.
• Maintains appropriate records of the Utilization Review Department.
• Participates in activities which enhance professional growth and development.
• Other duties as assigned.

Required Skills and Experience:

• High school, - preferably college -, level reading, writing, and math skills
• Excellent telephone usage skills and strong verbal skills
• Knowledge of health care service delivery systems and third-party reimbursement
• Understanding of admission and discharge function
• Familiarity with medical terminology, diagnostic terms and treatment modalities
• Knowledge of medical record keeping
• Strong interpersonal, organizational, evaluative, and time management skills
• Policy interpretation skills
• Familiarity with applicable standards and regulations
• Able to comprehend psychiatric evaluations, consults, lab results, etc.
• Flexibility
• Attention to detail
• Responsiveness to deadlines
• Assertiveness, persistence, and persuasiveness
• Able to work with minimal direction or supervision

Required Education:

• Graduate of accredited RN/LVN program and current RN/LVN license or Master’s level training in a behavioral health field.

Preferred Education, Experience, and Certifications:

• Experience in psychiatric field preferred.

Physical Requirements:

• Use standard office equipment and access, input, and retrieve information from a computer.
• Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
• Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information.
• Vision sees details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side.
• Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
• Walk and/or stand for long periods of time (3/4 of the workday).
• Lift up to fifteen (15) pounds.

While performing the duties of this job, this position is frequently required to do the following:

• Use standard office equipment and access, input, and retrieve information from a computer.
• Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
• Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information.
• Vision sees details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side.
• Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
• Walk and/or stand for long periods of time (3/4 of the workday).
• Lift up to fifteen (15) pounds.

Conditions of Employment

In compliance with API’s policies and guidelines, all API employees are required to adhere to the following:

Background/Reference Check & Licensure/Certification

• Completion of a satisfactory background and reference checks.
• Employee signed employment non-compete/confidentiality agreement
• Individuals whose position may require licensure, registration or certification must maintain such as current and valid. It is the employee's responsibility to send updated copies to Human Resources before the expiration date. It is the employee's responsibility to notify Human Resources of any changes or proposed changes in status to licensure, registration, or certification. Failure to do so could result in employee suspension.

Flu Vaccinations; Medical

• Annual Flu vaccination is required as a condition of hire and ongoing employment. Only those who are allergic to the vaccine or meet contraindications as indicated on the current CDC Vaccine Information Statement shall be exempt from this condition of hire and ongoing employment but are required to wear a mask while inside an API owned or operated building or vehicle during influenza season, Employees must provide physician documentation to support any reported allergy or contraindication. Flu season typically runs between November and March.
• Pass drug and alcohol test performed by Concentra.
• Clear TB skin test or Chest X-Ray at Concentra.
• Complete a satisfactory physical examination at Concentra designed solely to determine your ability to perform the duties of the position being offered.

EEO Statement

API provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.