UR Case Management Specialist

The UR Case Management Specialist provides leadership in the facilitation of the treatment process from admission to discharge. The UR Case Management Specialist monitors the treatment process, acting on behalf of the best interest of the patients, their families, and Rogers Behavioral Health to manage risk, ensure quality patient care and cost/quality outcomes. The UR Case Management Specialist collaborates with other departments to resolve identified care delivery issues at Rogers Behavioral Health.

Responsibilities

Act as liaison between RBH and third-party payers in advocating for medical necessity authorization; Provide utilization information to third-party payors and facilitate physician-to-physician (peer to peer) reviews or expedited appeals; Act as liaison between RBH, third-party payers, and non-RBH providers to ensure aftercare is complete with appointments scheduled; Attend and participate in interdisciplinary treatment team meetings; Review active medical records to ensure medical necessity documentation requirements are met; Initiate the physician advisory review process as needed; Provide leadership in aftercare planning by coordinating the discharge planning process between all stakeholders; Ensure discharge planning process begins at admission; Complete aftercare plans prior to discharge; Arrange for community resources to facilitate discharge; Support process improvement initiatives within the UR department; Provide professional communication and customer service to all stakeholders; Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations

Requirements

Bachelor’s Degree or four (4) years of direct utilization review, discharge planning, or case management experience in a behavioral health setting; Two (2) years previous work experience; Computer skills, including word processing, spread sheets and data processing; Knowledge of Joint Commission documentation and medical records standards and ability to maintain accurate records; Current American Heart Association CPR certification or American Red Cross Professional Rescue required within thirty (30) days of date of hire, bi-annual re-certification required; Formal training in the management of the aggressive patient (S.A.F.E.) required within sixty (60) days of date of hire, annual re-certification required

Nice to have

Knowledge of managed care, Medicaid and Medicare; Utilization review experience in a hospital, outpatient or managed care setting; Case management experience in a hospital, outpatient or managed care setting; Knowledge of the DSM, ICD-10, medical, mental health and chemical dependency diagnosis and treatment process; Office or hospital setting

Benefits

Health, dental, and vision insurance coverage; 401(k) retirement plan; Employee share program; Life/disability insurance; Flex spending accounts; Tuition reimbursement; Health and wellness program; Employee assistance program (EAP)