Utilization Review Case Manager

1 week ago

Irvine, United States Discovery Behavioral Health DBH Full time
Job DescriptionJob DescriptionCompany Description

At Discovery Behavioral Health, we know the best way to predict the future of healthcare is to create it.  As a member of our growing team, you will have a voice in the creation of life-changing programs and treatment centers nationwide.  Working collaboratively with the best and the brightest in our industry, you will be part of an innovative team of professionals committed to generating positive and remarkable outcomes for the clients we serve.

If you are looking for an organization that thrives on growth, celebrates diversity of thought, and rewards passionate execution, you’ve come to the right place.  Because we put clients first, it is our honor to support and reward those who serve them.

Compensation Range: $65-70k per year

Compensation will be dependent upon geographic region, education, and experience.

Our Offer to You

We are dedicated to empowering our employees with their professional and personal development by providing:   

  • 401(k)  
  • Healthcare benefits  
  • Vacation and sick days
  • Employee referral program 
  • Employee discounts to various stores, amusement parks, events, etc. 
  • Continuing education (CE) programs and training 
  • Weekly training opportunities  
  • Advancement opportunities within the organization 
Job Description

The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for our clients.  The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight timeline. 

Responsibilities

  • Determine client medical necessity for insurance claims using various criteria and dimensions as dictated by the insurance carriers
  • Work to build a case for medical necessity for potential clients
  • Perform pre-intake assessments for potentially viable clients
  • Work closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of care
  • Conduct chart reviews to ensure clinical documentation matches level of care requested
  • Ensure that authorization match the authorization obtained by you for the correct authorization number, the LOC , the facility, the number of days and the date range.
  • Understanding DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all Levels of care.
  • Communicate effectively, both written and verbal, with supervisor and all pertinent staff on your clients.
  • File appeals for denied cases and follow through on that process
  • Timely, organized documentation.  Record keeping must be accurate and thorough.
  • Demonstrate the ability to act as a team player in a professional and positive manner

 

Qualifications

  • Required Master’s Degree minimum
  • Licensed LMFT, LCSW, LVN, or RN
  • Prior experience in doing utilization review 
  • Strong knowledge of ASAM dimensions 1-6
  • Knowledge of DSM-V Codes
  • Knowledge of SUD,IOP, and Mental Health programs
  • Flexibility with schedule to meet critical deadlines is essential.

Not sure if you meet all the qualifications? Apply anyway To provide truly innovative care, we need to have a diverse team around us. That’s why Discovery Behavioral Health is committed to creating an inclusive environment. If you find yourself meeting some but not all the above, we’d be happy to consider your application.



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/

Discovery Behavioral Health seeks to build a diverse staff that is reflective 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.

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