Utilization Review Case Manager - Partial Hospitalization

Luminis Health, Inc.; Annapolis (MD); Sur place; USD 82 000 - 123 000; Plein temps

Avantages offerts par ce poste

Medical, Dental, Vision

Retirement Plan with employer match

Paid Time Off

Tuition Assistance

Employee Referral Bonus

Paid Holidays and Disability

Wellness Programs

Employee Assistance Programs

Résumé du poste

Luminis Health in Lanham, MD is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program. The role performs integrated utilization review and coordinates referrals, working with medical staff to gather documentation and determine medical necessity for admission and placement.

Requirements include a BA/BS and at least two years in utilization review or utilization management. The position involves pre-authorizations, concurrent reviews with external reviewers, and

Qualifications

• BA/BS degree required.
• Two years of utilization review or utilization management experience preferred.
• Ability to coordinate with medical staff and payors.

Responsabilités

• Performs and monitors integrated utilization review and case referrals on patients.
• Obtains appropriate clinical documentation for review and optimal patient placement.
• Maintains contact with Managed Care and other third party payors for approval and placement.
• Pre-authorizes patients and conducts concurrent reviews with external review agents.
• Consolidates, tracks and reports performance on utilization review forms for all clinical areas.

Connaissances

Utilization review

Case management

Communication

Formation

BA/BS Degree

Description du poste

Luminis Health in Lanham, MD is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program. The role performs integrated utilization review and coordinates referrals, working with medical staff to gather documentation and determine medical necessity for admission and placement.

Requirements include a BA/BS and at least two years in utilization review or utilization management. The position involves pre-authorizations, concurrent reviews with external reviewers, and