Case Manager UR

Job Title: Utilization Review (Case Manager)

FLSA Status: Non-exempt

Program: Progressive PHP of Seaside Health System

Reports To: Clinical Supervisor/Assistant Clinical Supervisor

Position Summary

The Utilization Review (Case Manager) is responsible for organizing and providing quality information required

to advocate for pre-certifications and authorizations from insurance companies for our patients.

Required Knowledge, Skills, Licensure, Training & Travel Requirements (if applicable):

Education: Must have Bachelor’s degree in related field. Must maintain certification in CPR and CPI.

Work experience: Experience with Utilization Review in behavioral health and government assistance preferred.

Knowledge, Skills & Abilities: Must possess good verbal and written communication skills. Should be computer literate. Completes assignments accurately, in a timely manner, and within procedural guidelines. Organizes and prioritizes work.

Interpersonal Skills: Possess excellent interpersonal skills to help facilitate the development of rapport with patients and their family members, referral sources; and to work cooperatively with in-house physicians, and administrative, clinical and support staff members. Displays self-direction by seeking solutions to problems. Seeks out and offers new ideas for improving processes. Deals constructively in stress.

General Performance: Must display willingness to help others. Uses appropriate customer etiquette, e.g., telephone, conversation, demeanor, etc. Takes direction well, accepts constructive criticism and responds accordingly. Respects customer’s, co-worker’s, and organization’s confidentiality. Follow policies/procedures such as appearance, dress, safety, appropriate patient/staff interactions, etc. Works positively with both internal and external customers. Is punctual in all aspects of work. Adheres to attendance policy.

Travel Requirements: None.

Essential Job Duties & % of Time

• Provides direct patient care by assisting patients with all aspects of case management needs (i.e., helping patients find the best resources needed.) - 25%
• Assists patient and treatment team in UR functions · Obtaining pre-certifications and authorizations from insurance companies to ensure treatment coverage and payment- 25%
• Participates as an active member of treatment team - 15%
• Facilitates psychoeducation groups and document on assigned caseload - 30%
• Other duties as assigned/required - 5%

Guidance Requirement: Indicate the degree to which the position is guided by the Supervisor/Manager

Procedures well established. Few decisions made. Supervisor readily available as needed.

Physical Effort Requirement:

Physical Effort found in normal office environment.