Job Description

The UTILIZATION REVIEW CASE MANAGER requires effective communication and coordination with the Director of Utilization Review, insurance companies, admissions coordinators, and treatment team to obtain the maximum benefits for our clients. You will have oversight of Discovery Behavioral Health Programs. You will make sure you can submit accurate utilization reviews in an extremely tight timeline. Good verbal and written communication skills is required. Record keeping must be accurate and thorough. You must be able to discern medical necessity to for a busy and growing drug, alcohol, and mental health facility. Flexibility with your schedule, so that you can meet critical deadlines as established, is essential.

RESPONSIBILITIES

• Conduct pre-authorizations for admitting clients that require it based on payer, geography or low acuity.
• Provide clinical guidance and support to the Admissions Coordinators as it relates to medical necessity criteria and appropriate level of care.
• Conduct weekly UR office hours/consultation groups.
• Track and closely monitor authorization status and length of stay and provide coaching/support and direction in order to increase funded length of stay
• Create, implement and enforce UR policies and procedures.
• Create and maintain UR manual including payer specific criteria guidelines and disseminate to all clinical staff.

This is a FULL-TIME REMOTE position.

Qualifications

• Required Bachelors Degree, Master’s Degree preferred
• Licensed LMFT, LCSW, LPCC, or RN
• Prior experience in doing utilization review for mental health facilities
• Strong knowledge of medical necessity criteria
• Knowledge of DSM-V Codes
• Previous employment working with Mental Health Disorder’s preferred.
• Knowledge of RTC, PHP, and IOP Mental Health programs

Additional Information

We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, or national origin.

For more information about our company benefits, please visit us at discoverybehavioralhealth.com/careers/