Clinical Case Manager Behavioral Health FT, Day

4 months ago


Columbia, United States Prisma Health Full time

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 Rd

Facility

1502 Behavioral Care

Department

15026601 Behavioral Care Day Treatment

Share 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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