Utilization Review & Case Manager – Behavioral Health

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

Benefits offered by this job

Medical/Dental/Vision Insurance

Retirement Plan

Paid Time Off

Tuition Assistance

Employee Referral Bonus

Holidays, Disability & Life/AD&D

Wellness Programs

Employee Assistance Programs

Job summary

Luminis Health in Lanham, MD seeks a Utilization Review/Case Manager for the Partial Hospitalization Program. The role involves coordinating utilization reviews, obtaining clinical documentation, and interfacing with managed care to ensure appropriate patient placement and authorization.

Requirements include a BA/BS and at least two years of utilization review/management experience. Exempt, full-time position with competitive pay and benefits.

Qualifications

• BA/BS 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 appropriate clinical documentation for review and optimal patient placement.
• Maintains contact with Managed Care and other third party payors to assure appropriate case management.
• Assesses data reflective of the patient’s status and interprets information to identify age-specific needs.
• Evaluates data to determine patient eligibility for admission or referral.
• Verifies pre-admission assessment and authorizations as applicable.
• Monitors records for medical necessity and continuation of stay.
• Reports performance data to the Clinical Director and treatment team.
• Initiates and follows up on appeals where necessary.

Skills

Utilization review

Case management

Education

BA/BS

Job description

Luminis Health in Lanham, MD seeks a Utilization Review/Case Manager for the Partial Hospitalization Program. The role involves coordinating utilization reviews, obtaining clinical documentation, and interfacing with managed care to ensure appropriate patient placement and authorization.

Requirements include a BA/BS and at least two years of utilization review/management experience. Exempt, full-time position with competitive pay and benefits.