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UM Case Manager For Behavioral Health

Florence, SC



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  


Full time


Florence, SC, United States


Full time

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