Utilization Review & Case Manager - Behavioral Health

Luminis Health; Bowie (MD); On-site; USD 82,000 - 123,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Retirement Plan with employer match

Paid Time Off

Tuition Assistance Benefits

Employee Referral Bonus Program

Paid Holidays, Disability, and Life/AD

Wellness Programs

Employee Assistance Programs

Job summary

Luminis Health in Bowie, MD, is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program. The role performs concurrent utilization review and manages case referrals, collaborating with clinical staff to secure documentation for review and optimal patient placement.

In coordination with managed care and external payors, you will ensure appropriate case management, determining admission, pre-authorization, and ongoing review across clinical areas.

Qualifications

• BA/BS degree required.
• Two years of experience performing utilization review or utilization management.

Responsibilities

• Performs and monitors integrated, concurrent utilization review and case referrals on patients.
• Works with medical and professional staff to obtain clinical documentation for review and placement.
• Maintains contact with Managed Care and third party payors to assure appropriate case management.
• Determines medical necessity and appropriateness of admission using established criteria.
• Pre-authorizes patients and monitors medical records for continued stay.

Education

BA/BS

Job description

Luminis Health in Bowie, MD, is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program. The role performs concurrent utilization review and manages case referrals, collaborating with clinical staff to secure documentation for review and optimal patient placement.

In coordination with managed care and external payors, you will ensure appropriate case management, determining admission, pre-authorization, and ongoing review across clinical areas.