Utilization Review Case Manager

The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and retrospective review of inpatient admissions and services. This position will obtain authorization for each admitted patient. Review and monitor each step of the authorization process to proactively identify potential problems to help patients access the full range of their benefits through the utilization review process.

• Conducts admission reviews.
• Conducts concurrent and extended stay reviews.
• Prepares and submits appeals to third party payors.
• Maintains appropriate records of the Utilization Review Department.
• Performs related duties, as requested.
• Upholds the Organization's ethics and customer service standards.

*This position is on-site and NOT a remote position.*

Requirements

• Education: Clinical degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or related experience.
• Required Licenses: RN or LVN license preferred
• Experience: Two years clinical experience in a facility with medical terminology and in criteria for acute psychiatric care or combination of education and exp