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Clinical Case Manager Behavioral Health FT, Day
1 month ago
Inspire health. Serve with compassion. Be the difference.
Job Summary
Performs systematic reviews of clinical documentation establishing medical necessity and obtaining authorization for treatment from third party payors. Documents utilization review process and provides communication to treatment team or other parties as needed.Serves as an additional clinical resource for the department as directed by the manager. Provides direct and indirect counseling services to patients and their families using individual, group, and family therapy. Provides bio-psychosocial assessments, risk assessments, treatment planning and coordination with multidisciplinary team. Remains open to clinical and peer supervision process.
Accountabilities
Conducts comprehensive review of clinical information gleaned from medical records, referral sources, treatment team, etc. to communicate with and obtain authorization from third party payers. 50%
Records authorization numbers and other utilization review data into EPIC (EMR) - 15%
Obtains benefit profile for patient coverage including active plan coverage and deductibles. 10%
Generates appeals for denials of authorization and coverage 10%
Maintains log of current in network payers to inform decision making for admissions and discharges- 10%
Serve as an additional resource for the department including any clinical or administrative duties as requested by the manager. 5%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Hiring Requirements
Master's degree in social work or counseling
2 years professional experience in a behavioral health setting preferred
In lieu of
In lieu of a Master's degree in social work or counseling, will accept an AD N, BSN or MSN in Nursing
Work Shift
Day (United States of America)Location
Baptist Gracern RdFacility
1502 Behavioral CareDepartment
15026601 Behavioral Care Day TreatmentShare your talent with us Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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