UM Case Manager For Behavioral Health
Utilization Management Case Manager for Behavioral Health
Essential Functions • Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. • Coordinates/facilitates patient care progression throughout the continuum of care. • Assures the plan of care and services provided are patient focused, high quality, efficient and cost effective. • Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered. . • Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas. • Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors. • Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form. • Insures that all payer communication is documented for the care team as well as billing. • Ability to cover various populations across the organization in relation to Utilization Review. • Performs all other duties as requested by Case Manager Supervisor and/or Director.
Work Schedule: 80 Hours. Full Time
Qualifications/Training • 1-2 years of recent acute care hospital experience required • Data entry/computer experience required
Licenses/Certifications/Registrations/Education • Registered Nurse from an NLN accredited school of nursing required • Licensed LPN or RN to practice within the applicable region of employment and coverage area of responsibility is required
Florence, SC, United States