UR Case Manager: Treatment Coordination & Aftercare

Milwaukee Succeeds; Town of Oconomowoc (WI); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k)

Employee share program

Life/disability insurance

Flex spending accounts

Tuition reimbursement

Health and wellness program

Employee assistance program (EAP)

Job summary

Rogers Behavioral Health is seeking a UR Case Management Specialist to lead the care coordination from admission through discharge. You will collaborate with clinical teams, payers, and patient financial services to secure medical necessity authorizations and optimize outcomes.

You will participate in interdisciplinary teams, ensure compliant documentation, and guide aftercare planning. A Bachelor's degree and UR-related experience are preferred, with ongoing training requirements and a

Qualifications

• Bachelor's Degree required; Behavioral Science or Human Services preferred.
• Two years' experience in office or hospital setting preferred.
• Knowledge of managed care, Medicaid and Medicare is preferred.
• Utilization review experience in a hospital, outpatient or managed care setting preferred.
• Case management experience in a hospital, outpatient or managed care setting preferred.
• Knowledge of DSM, ICD-10, medical, mental health and chemical dependency diagnosis and treatment process is preferred.
• Computer skills including word processing, spreadsheets and data processing.
• Knowledge of Joint Commission documentation and medical records standards.
• CPR certification (AHA/RED CROSS) within 30 days; bi-annual recertification.
• Formal training in S.A.F.E. management within 60 days; annual recertification.

Responsibilities

• Coordinate and track patient care between RBH, payers and providers to ensure medical necessity authorization.
• Act as liaison to ensure aftercare is complete with appointments scheduled.
• Attend interdisciplinary treatment team meetings.
• Review active medical records to verify documentation meets medical necessity requirements.
• Communicate with UR leadership, admitting leadership, and clinical leadership about documentation quality.
• Provide feedback and training to clinical staff on medical necessity documentation.
• Initiate physician advisory reviews as needed.
• Lead liaison between admissions, clinical teams, payer strategies and patient financial services.
• Inform UR leadership of sensitive cases with potential contractual implications.
• Work with regulatory/quality to identify and resolve risk-related issues.
• Maintain resources list in accordance with best practice.
• Adhere to Standard Work and documentation timelines.

Skills

Leadership

Care coordination

Communication

Regulatory compliance

Interdisciplinary collaboration

Education

Bachelor's Degree in Behavioral Science or Human Services

Tools

EHR systems

Job description

Rogers Behavioral Health is seeking a UR Case Management Specialist to lead the care coordination from admission through discharge. You will collaborate with clinical teams, payers, and patient financial services to secure medical necessity authorizations and optimize outcomes.

You will participate in interdisciplinary teams, ensure compliant documentation, and guide aftercare planning. A Bachelor's degree and UR-related experience are preferred, with ongoing training requirements and a