CASE MANAGER BEHAVIORAL HEALTH

Job description

- Utilization - Completes initial utilization review for medical necessity for an assigned patient population. - Initiates assessment within 24 hours of admission or next business day. - Applies Interqual criteria for severity of illness/intensity of service indicators/medical necessity criteria as appropriate. - Recognizes and progresses the plan of care when an alternative level of care is appropriate. - Conducts continued stay reviews by monitoring patient's response to treatment and resource utilization. - Collaborates with Attending Physician and healthcare team to facilitate the progression of the plan of care. - Completes initial and continued stay reviews in a timely manner, in accordance with various payor contracts and guidelines. - Cognizant of payor requirements for all patients in assigned caseload. - Responsible for accurate and timely documentation in recognized data bases to support Clinical Resource Management components for each patient in assigned caseload. - Denial Management - Initiates contact with Attending Physician on all cases that do not meet SI/IS indicators to clarify plan of care. - Educates physicians and other members of the healthcare team on the ap...