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Overview:

PURPOSE STATEMENT

Manage patient cases with a high degree of clinical knowledge and expertise.

Responsibilities:

ESSENTIAL FUNCTIONS

Assure that patients meet care criteria from admission through discharge. Initiate authorization with network providers. Maintain knowledge of clinical information for patient's stay by review of documentation, participate in staffing, attend care conferences and collaborate with other members of the treatment team. Perform concurrent review with network providers; monitor medical record documentation using knowledge of established guidelines to promote compliance and further ensure quality for retrospective review by external review entities Liaison with physician and other treatment team members to assure that all aspects of treatment are fully documented. Lead the flow of information between levels of care by collaborating with the admissions department, clinical and financial departments, and the patient and their family/guardian throughout program to provide a smooth transition at discharge. Coordinate resources with other community services and agencies. Discuss appropriateness of a continued stay or continued care by the facility with the multi-disciplinary team, third-party case managers, physicians and other departments.

OTHER FUNCTIONS

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

Bachelor's degree in Social Work, Counseling or related human service field required. Licensed health care professional with mental health experience (MSW; LCSW; RN; CNS; ARNP; Registered Mental Health Professional (MHP); Counselor (MA; MFT) required. Three or more years' experience working in a behavioral health setting required.

LICENSES/DESIGNATIONS/CERTIFICATIONS

Licensure or certification for counseling, as may be required by the state in which the facility operates. CPR and de-escalation/restraint certification required (training available upon hire and offered by facility). First aid may be required based on state or facility.

ADDITIONAL REGULATORY REQUIREMENTS

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws. 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Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Moosic, Pennsylvania

Case Manager III