Utilization Review Case Manager

From residential programs to hybrid and outpatient care, AMFM Healthcare is proud to offer a full continuum of mental health treatment options, delivered by passionate professionals who believe in treating the whole person—not just the diagnosis.

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Qualifications

1. Must be 18 years or older to apply for this position.

2. Ability to pass a standard background check.

3. Minimum Education Requirement

High School Diploma or equivalent.

4. At least 6 months experience working in the behavioral health or substance abuse field, with knowledge of general medical necessity and insurance criteria.

5. Physical Requirements

Ability to work on a computer/keyboard, type a minimum of 40 words per minute, use electronic systems, communicate with others through written and verbal formats, ability to sit for long periods of time, listening, reading comprehension, lifting up to 10 lbs.

To perform this job successfully, an individual must be able to perform each essential job function assigned satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills, and Abilities

1. Excel at both written and verbal communications to convey essential information; must be able to utilize the proper linguistic syntax and spelling.

2. Ability to use computer software including Microsoft Office, Adobe Acrobat, and G Suite products.

3. Knowledge of clinical and medical terminology as it relates to the delivery of clinical care to the clients within our programs.

4. Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners, and shredders.

5. Ability to be professional and maintain a positive attitude and relationships with coworkers.

6. Ability to communicate with people outside the organization, representing the organization to customers, the public, government, and other external sources.

Duties: And responsibilities:

The Utilization Review Case Manager will be assigned projects, based on his/her level of expertise, that include any, or all the following job responsibilities.

1. Timely and effective management of the individual caseload to include all assigned initial, concurrent, and discharge reviews.

2. Effectively communicate any deficiencies in chart/clinical documentation to the clinical team to ensure documentation is aligned with insurance company guidelines and standards.

3. Engage in strong advocacy for clients utilizing insurance, ensuring optimal length of stay.

4. Exemplify time management skills by scheduling peer reviews and appeals with available licensed providers as soon as possible, to minimize risk of uncovered days and/or lack of claim reimbursement.

5. Collaborate with the Director of Utilization Review and UR team on changes to LOC, authorization status, and complicated or time sensitive cases to better ensure optimal outcomes.

6. Keep accurate organizational notes and records for all actions completed related to the assigned caseload throughout all applicable spreadsheets.

7. Engage in any and all assigned training by the Director of Utilization Review to sharpen skill set, and increase knowledge of behavioral health utilization review.

8. Effectively relay any information shared by insurance care managers for collaboration of care to the appropriate AMFM clinical team.

9. Collaborate with the discharge planning team and clinical case managers by relaying any insurance information necessary to ensure a smooth and appropriate discharge plan for the individual assigned caseload.

10. Demonstrate a professional attitude and support the objectives of the facility philosophy through internal and external communications and interactions with all levels of staff, patients, community and referral sources.

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Benefits

• for full time employees:
• Medical, Dental, and Vision plans through Anthem or Kaiser.
• FSA/HSA Accounts.
• Life/AD&D insurance through Anthem, 100% paid for by the employer.

Other benefits include

• 401k plan with employer match.
• PTO, Self Care Day, and Floating Holiday.
• Educational Assistance Reimbursement Program.
• Employee Assistance Program.
• Health and Wellness Membership.

Application Instructions

Please submit your resume directly through this online job posting to be considered. We thank you for your interest in joining our team.

We are committed to providing reasonable accommodations to ensure equal opportunities for all candidates. If you require assistance or an accommodation due to a disability during the application process or while employed, please contact our HR department. We believe in creating an inclusive work environment where every individual can thrive.

AMFM Healthcare is committed to providing equal employment opportunities to all employees and applicants without regard to race, ethnicity, religion, color, sex (including childbirth, breast feeding and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age, protected medical condition, genetic information, disability, or any other protected status in accordance with all applicable federal, state and local laws.