Utilization Review/Case Manager

Freedom Behavioral; West Monroe (LA); Vor Ort; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

Medical

Dental

Vision

401k

Life and Disability

Zusammenfassung

Freedom Behavioral Hospital of Monroe is seeking an Utilization Review/Case Manager to coordinate patient care services and manage utilization review functions. You will act as the liaison between the hospital, payors, patients, families, and referral partners to support clinical and financial outcomes.

Responsibilities include securing authorizations, developing discharge plans, documenting activities, and collaborating with external agencies for aftercare.

Qualifikationen

• Strong understanding of behavioral health levels of care and medical necessity
• Ability to communicate with multidisciplinary teams, payors, patients and families
• Excellent organizational, documentation, and time management skills
• Knowledge of regulatory and accreditation standards for case management and utilization review
• Ability to manage multiple priorities with accuracy and compliance

Aufgaben

• Coordinate with Admissions and Clinical staff to ensure patient needs are met
• Conduct utilization review activities and secure insurance authorizations
• Serve as primary contact with payors for medical necessity and level of care
• Develop and manage discharge plans for safe transitions of care
• Communicate with patients, families, and referral sources to support outcomes
• Present clinical information to the treatment team and participate in meetings
• Maintain communication with physicians, nursing, social services for coordinated care
• Document utilization review and discharge planning in the medical record
• Collaborate with external agencies/providers for aftercare and continuity
• Uphold patient rights, confidentiality, and ethical standards
• Participate in Performance Improvement and Quality Management activities

Kenntnisse

Behavioral health

Regulatory compliance

Communication

Discharge planning

Documentation

Jobbeschreibung

The Utilization Review/Case Manager is responsible for coordinating patient care services and managing utilization review functions to ensure appropriate level of care, timely insurance authorization, and effective discharge planning. This role serves as the primary liaison between the hospital, payor sources, patients, families, and referral partners to support optimal clinical and financial outcomes.

In accordance with The Joint Commission standards, federal and state regulations, and Freedom’s mission, policies, and Performance Improvement (PI) program, the Case Manager facilitates the continuum of care from admission through discharge.

Key Responsibilities

• Coordinates with Admissions and Clinical staff to ensure patient treatment needs are identified and met throughout the stay
• Conducts utilization review activities, including securing initial and continued stay authorizations from insurance providers
• Serves as the primary point of contact with payors, communicating medical necessity, level of care, and continued stay criteria
• Develops, implements, and manages discharge plans to ensure safe and appropriate transitions of care
• Communicates effectively with patients, families, and referral sources to support positive treatment outcomes
• Gathers and presents clinical information to the multidisciplinary treatment team; actively participates in treatment team meetings
• Maintains consistent communication with physicians, nursing, social services, and other disciplines to ensure coordinated care delivery
• Documents all utilization review and discharge planning activities accurately and timely in the medical record, supporting intensity of service and medical necessity
• Collaborates with external agencies and providers to coordinate aftercare services and continuity of care
• Ensures patient rights, ethical standards, and confidentiality are upheld at all times
• Participates in Performance Improvement (PI) and Quality Management (QM) activities, including data collection and process improvement initiatives

Qualifications & Skills

• Strong understanding of behavioral health levels of care, medical necessity criteria, and insurance authorization processes
• Ability to effectively communicate with multidisciplinary teams, payors, patients, and families in a professional manner
• Excellent organizational, documentation, and time management skills
• Knowledge of regulatory and accreditation standards related to case management and utilization review
• Ability to manage multiple priorities while maintaining accuracy and compliance

Excellent Benefit Package Offered For Full-Time Employees

• Medical
• Dental
• Vision
• 401k
• Life and Disability

Freedom Behavioral Hospital of Monroe 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 any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.