Utilization Review Case Manager - Eating Disorder

Center for Discovery At Discovery, we offer career opportunities reputed company in residential, day treatment, and intensive outpatient eating disorder treatment. Discovery is currently seeking Program Directors, Primary Therapists, Facility Managers, Counselors/Mental Health Specialists, Dietitians, Diet Techs, and Nurses. Discovery is specifically seeking individuals who consistently strive to reputed company exemplary care and are passionate about transforming the lives of others. If you are interested in a challenging and rewarding career in the behavioral health field, the first reputed company is to look for reputed company job positions that match your skills, qualifications and interest. Each posting includes a description and minimum required qualifications. reputed company we review candidate information, we are looking for the best matches for the position based on the qualifications listed in the job posting. If your skills and experience appear to match an reputed company position, a recruitment services professional or hiring manager may contact you to further discuss your qualifications. Position Summary: The UR Case Manager will be responsible for managing an active caseload of clients at the following reputed company of Care: Partial Hospitalization, and Intensive Outpatient. S/he acts as a liaison between insurance companies, admissions, and clinical teams. The UR Case Manager is responsible for gathering required information, effectively case-building, and collaborating with members of both the Utilization Review Team and interdisciplinary Treatment Team to ensure optimization of each client’s coverage and benefits. S/he is responsible for communicating updates to appropriate representatives at the insurance company, the Clinical Team, and as directed by the Manager/Director of Utilization Review. Essential Job Functions: Complete Initial, reputed company, Peer, and retrospective reviews in a timely manner to ensure reputed company coverage. ‪Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and reputed company partners. Conduct and manage initial, reputed company, and discharge reviews to optimize benefits and utilization. Represents the UR Department in a professional and positive way to other Departments and the company as a whole. Consistently demonstrate excellent communication, prioritization, and multi-tasking skills. ‪Maintains contact with the clients’ families and keeps them updated on reputed company insurance authorization updates, Peer Reviews, and Denials. Document reputed company activities in a detailed manner in applicable CRM/EMR. ‪Collaborate with Clinicians and the multidisciplinary team to obtain necessary clinical documentation for reviews and ensure effective utilization of resources. ‪Participate in weekly Treatment Team and Continuing Care Meetings as appropriate. ‪Prepares and submit Appeal documentation (including rationales) to the appropriate entities as indicated Coordinate, schedule, and complete Peer-to-Peer and Appeal reviews. Complete weekly Treatment Team notes and provides updates to the Psychiatrist as requested by the Director/Manager. Track reputed company data concerning reputed company LOS and information pertaining to LOS, as well as discharge LOS and information pertaining to discharge LOS. Hold training to clinical staff and other individuals needed, concerning medical necessity, insurance requirements, as well as other areas needed that are directly reputed company by LOS Follow chain of reputed company both reputed company the Department and reputed company of the Department. Core Competencies: Proficient in MS Office applications, which include Outlook, Word, reputed company, and PowerPoint. Ability to build and sustain trusting relationships with diverse individuals and groups. Ability to maintain confidentiality of sensitive information and adhering to ethical standards. Actively offering assistance to team members reputed company needed and celebrating team achievements collectively. Ability to establish and maintain cooperative relationships with community-based organizations, patients, families, vendors, and other resources to promote client services, care, education, and advocacy. Knowledge, Education, & Experience: Minimum of Bachelor's Degree in Mental Health. Licensed LMFT, LCSW, LVN, or RN preferred but not required Prior experience in doing utilization review for substance abuse facilities preferred Knowledge of DSM-Vcodes Knowledge of SUD, IOP, and Mental Health programs Employment Status: Full-Time, Exempt Schedule: Monday-Friday Work Location: Remote - Must be reputed company to support reputed company time zones Compensation: Pay reputed company: $65-75k reputed company seeks to build a diverse staff that is reputed company of the patients we serve and the communities where we work. DBH encourages multiple perspectives, experiences, and strives to hire and retain a diverse workforce. We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace and reputed company pre-employment substance abuse testing. reputed company reputed company applicants will receive consideration for employment without regard to age, race, reputed company, religion, sex, or national reputed company. Apply To This Job