Utilization Review/Case Manager

Freedom Behavioral Hospital of Monroe; West Monroe (LA); Presencial; USD 52.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical

Dental

Vision

401k

Life and Disability

Descripción de la vacante

Freedom Behavioral Hospital of Monroe is seeking an experienced Utilization Review/Case Manager to coordinate patient care, manage utilization review functions, and secure insurance authorizations. You will liaise with the hospital, payors, patients, families, and referral partners to support clinical and financial outcomes.

Responsibilities include discharge planning, collaboration with the treatment team, documentation, and participation in PI/QM activities.

Formación

• Strong understanding of behavioral health levels of care, medical necessity criteria, and insurance authorization processes.
• Ability to 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.

Responsabilidades

• Coordinate with Admissions and Clinical staff to identify and meet patient treatment needs.
• Conduct utilization review activities, securing initial and continued stay authorizations.
• Serve as primary contact with payors, communicating 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 and nursing to ensure coordinated care.
• Document utilization review and discharge planning in the medical record.
• Collaborate with external agencies to coordinate aftercare.
• Uphold patient rights, ethical standards, and confidentiality.
• Participate in Performance Improvement and QM activities including data collection.

Conocimientos

Behavioral health care levels

Medical necessity criteria

Insurance authorization

Descripción del empleo

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.