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Utilization Review Case Manager Non-RN
2 months ago
Steward Health Care is a leading healthcare organization that provides high-quality, patient-centered care to individuals and communities. Our mission is to revolutionize the way healthcare is delivered, creating healthier lives, thriving communities, and a better world.
Job SummaryWe are seeking a skilled Utilization Review Case Manager Non-RN to join our team at Steward Health Care. The successful candidate will be responsible for validating the medical necessity of patient admissions and ongoing services, verifying or obtaining authorization from third-party payors, and coordinating care with the multidisciplinary team.
Key Responsibilities- Validate the medical necessity of patient admissions and ongoing services
- Verify or obtain authorization from third-party payors
- Coordinate care with the multidisciplinary team
- Identify various levels of treatment available for patients and work closely with the team to coordinate continued care and services
- Advocate for appropriate discharge planning, including next-level care
- Identify Steward Health Care programs, individual providers, and community resources, and document options in medical records
- Ensure reimbursement from third-party payors through the appeal process
- Complete CMS forms and place them in medical records
- Master's degree preferred from an accredited university in a behavioral health field with 3 years of experience
- Bachelor's degree required with 2 years of behavioral health experience
- Certified Case Manager (CCM) certification
- Basic computer knowledge
- Ability to communicate verbally and in writing in the English language
As a Utilization Review Case Manager Non-RN at Steward Health Care, you will have the opportunity to work in a dynamic and patient-centered environment. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
