Utilization Review & Case Management Specialist

Freedom Behavioral Hospital of Monroe; Monroe (LA); On-site; USD 45,000 - 65,000; Full time

Job summary

Freedom Behavioral Hospital of Monroe is seeking an Utilization Review representative to assess patient data, determine medical necessity, and coordinate discharge planning. The role involves reviewing admissions, treatment plans, and length of stay to ensure compliance with governmental and insurer requirements.

Preferred backgrounds include psychology or nursing education, and current nursing or social work licensure.

Qualifications

• 1+ year coordinating utilization review and discharge planning activities
• Education preferred in psychology or nursing
• Licensure as a Nursing or Social Worker professional
• Strong verbal and written communication skills
• Good organizational and analytical abilities
• Proficient PC skills and ability to follow written/verbal instructions
• Basic understanding of DSM V and medical/psychiatric diagnoses

Responsibilities

• Review and authorize precertification requests for medical necessity
• Analyze patient records to determine admission legitimacy, treatment, and length of stay
• Coordinate with Case Management/Social Services and refer to medical director when needed
• Support concurrent reviews and appropriately extend length of stay when justified

Skills

Verbal communication

Organizational skills

Interpersonal skills

Analytical reasoning

Reading comprehension

PC literacy

DSM V knowledge

Medical/psychiatric knowledge

Education

Psychology major preferred

Nursing education

Job description

Freedom Behavioral Hospital of Monroe is seeking an Utilization Review representative to assess patient data, determine medical necessity, and coordinate discharge planning. The role involves reviewing admissions, treatment plans, and length of stay to ensure compliance with governmental and insurer requirements.

Preferred backgrounds include psychology or nursing education, and current nursing or social work licensure.