Utilization Review Case Manager: Care Coordination & Discharge

Rogers Behavioral Health, Inc.; West Allis (WI); On-site; USD 60,000 - 90,000; Full time

Job summary

Rogers Behavioral Health, Inc. in Wisconsin is seeking a UR Case Management Specialist to lead care coordination from admission through discharge.

You will advocate for medical necessity with payors, support aftercare planning, and collaborate with clinical leadership to ensure high-quality, cost-efficient patient care. You will participate in interdisciplinary teams, review documentation for compliance, and drive process improvements within the utilization review department to enhance outcomes

Qualifications

• Bachelor's Degree in Behavioral Science or Human Services is required.
• Two years of work experience in an office or hospital setting is required.
• Knowledge of managed care, Medicaid and Medicare is preferred.
• Utilization review experience in hospital, outpatient or managed care setting preferred.
• Case management experience in hospital, outpatient or managed care setting preferred
• Knowledge of the DSM, ICD-10, medical, mental health and chemical dependency diagnosis and treatment process is preferred.
• Computer skills are required, including word processing, spreadsheets and data processing.
• Knowledge of Joint Commission documentation and medical records standards and ability to maintain accurate records.
• Current American Heart Association CPR certification or American Red Cross Professional Rescue is required within 30 days of hire; bi-annual re-certification is required.
• Formal training in the management of the aggressive patient (S.A.F.E.) is required within 60 days of hire; annual re-certification is required.

Responsibilities

• Coordinate and track patient care across the treatment continuum.
• Act as liaison between Rogers Behavioral Health and third-party payors for medical necessity authorization and peer-to-peer reviews.
• Ensure aftercare planning and discharge planning coordination with all stakeholders.
• Attend interdisciplinary treatment team meetings and provide documentation and feedback to clinical leadership.
• Review medical records to ensure documentation meets medical necessity requirements; elevate issues as needed.
• Collaborate with admissions, clinical teams, payer strategies and patient financial services to secure authorizations and single-case agreements.
• Identify and resolve issues that place patients or Rogers at risk; communicate with UR leadership and regulatory teams.
• Support process improvement initiatives within the UR department for continuous quality care.

Education

Bachelor's Degree (Behavioral Science or Human Services)

Two years of previous work experience (office or hospital setting)

Knowledge of managed care, Medicaid and Medicare

Utilization review experience in hospital/outpatient/managed care

Case management experience in hospital/outpatient/managed care

Tools

Word processing

Spreadsheets

Data processing

Job description

Rogers Behavioral Health, Inc. in Wisconsin is seeking a UR Case Management Specialist to lead care coordination from admission through discharge.

You will advocate for medical necessity with payors, support aftercare planning, and collaborate with clinical leadership to ensure high-quality, cost-efficient patient care. You will participate in interdisciplinary teams, review documentation for compliance, and drive process improvements within the utilization review department to enhance outcomes