Behavioral Health – Case Manager

Behavioral Health — Case Manager

Bring your passion to THR so we are Better + Together.

Work location:

Texas Health Resources — Behavioral Health, Remote.

Work hours:

Full-time (40 hours) Monday — Friday 9:00AM — 5:00PM.

• Master’s Degree Counseling or Social Work Required

• 3 Years Clinical psychiatric or chemical dependency experience Required
• 6 Months in case management or utilization review Required
• Prior experience with EPIC EMR

• LMSW – Licensed Master Social Worker Upon Hire Required Or
• LCSW – Licensed Clinical Social Worker Upon Hire Required Or
• LPC – Licensed Professional Counselor Upon Hire Required Or
• LPC-A – Licensed Professional Counselor Associate Upon Hire Required Or
• CPR – Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required And
• ACPI – Advanced Crisis Prevention Intervention Training Upon Hire Preferred

• Identify cases requiring certification or re-certification for third party payors.
• Ensure reviews are initiated on all patients; conduct reviews on admission, continued stay and discharge as defined in behavioral health policies.
• Review the treatment plan and advocate for additional services as indicated.
• Consult with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete.
• Review records of patients according to approved criteria. Verify appropriateness of the admission, continued stay and concurrence with government/third party payor regulations. Document all actions per required processes. Notify supervisor if patient is not meeting criteria.
• Refer cases that do not meet criteria to supervisor, attending physician and other members of the treatment team as appropriate.
• Maintain records for all reviews completed, including documenting all activity with the third-party payor and notes the number of certified days, dates of contact, authorization codes, and reference numbers for approval/disapproval.
• Ensure the appropriateness of hospitalization or continued hospitalization in accordance with approved criteria.
• Maintain records of criteria and correspondence with external agencies and insurance companies for reference.

• Attend multidisciplinary treatment team.
• Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.
• Provide timely feedback to the attending physician and treatment team members concerning continuing certification of days/service.
• Collaborate with the treatment team and supervisor regarding continued stay and discharge planning issues.
• Ensure coordination of benefits regarding continuity of care decisions.
• Recommend and promote discharge planning activities that reflect patient medical necessity needs and third-party payor authorization.
• Coordinate discharge planning as needed between the third-party payor and discharge planner(s).
• Maintain current awareness of mental health activities in the community.
• Maintain an awareness of community and market-related activities, including knowledge of the activities of other providers, needs of local payors, and the political climate related to mental health.
• Remain current on all clinical techniques and age-related mental health competencies and provide direction to staff and facility personnel as needed.

• Attend other hospital committees, task force meetings, and participate in Continuous Improvement (CI) teams as assigned.
• Enhance the effectiveness and quality of the services provided by the organization.
• Identify and address utilization management issues by the appropriate individuals/committees.

• Maintain current knowledge of Medicare, federal and state regulatory requirements for documentation, record keeping, and patient rights.
• Report any observed deficiencies in Medicare, federal and state regulatory requirements to supervisor and administrative leaders as appropriate.
• Address potential utilization management issues with supervisor and administrative leaders to ensure appropriate…