Utilization Review & Case Manager - Partial Hospitalization

Luminis-Health; Lanham (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

Job summary

Luminis Health in Lanham, MD seeks an experienced Utilization Review/Case Manager for the Partial Hospitalization Program. You will perform and monitor integrated utilization review and case referrals with clinical staff to assure appropriate patient placement.

Requirements include a BA/BS and at least two years in utilization review or utilization management. Exempt status and strong documentation, communication, and data-tracking skills are required.

Qualifications

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

Responsibilities

• Performs duties according to established standards for age groups adolescence through geriatric.
• Assesses data reflective of the patients status and interprets information to identify each patient’s requirements.
• Identifies status of physical, social and psychological needs of the patient, family and significant others.
• Evaluates data obtained in the bio-psychosocial and nursing history and assesses patients and their families for admission or referral.
• Determines medical necessity and appropriateness of admission using established criteria.
• Verifies pre-admission assessment and pre-authorizes patients as applicable.
• Monitors medical records for medical necessity and continued stay.
• Verifies prior authorization data and performs concurrent reviews with external review agents.
• Consolidates, tracks and reports performance on completed utilization review forms.
• Resolves outliers and initiates/follows up on appeals.

Skills

Utilization review

Case management

Education

BA/BS

Job description

Luminis Health in Lanham, MD seeks an experienced Utilization Review/Case Manager for the Partial Hospitalization Program. You will perform and monitor integrated utilization review and case referrals with clinical staff to assure appropriate patient placement.

Requirements include a BA/BS and at least two years in utilization review or utilization management. Exempt status and strong documentation, communication, and data-tracking skills are required.