CASE MANAGEMENT: UTILIZATION REVIEW AND DISCHARGE PLANNER

Job Description

Job Description

Salary:

NOTICE TO APPLICANTS

Thank you for your interest in employment with our organization.This position is currently filled.However, we maintain ongoing recruitment efforts, and should this position become available, applications and rsums on file may be considered for future openings.

Position Summary

Freedom Behavioral Hospital is seeking a highly organized and patient-focused professional to serve as our Case Management: Utilization Review and Discharge Planner. This position is responsible for coordinating utilization review activities, obtaining insurance authorizations, managing discharge planning, facilitating continuity of care, and ensuring patients receive appropriate services throughout their hospitalization and transition back into the community.

The Case Management: Utilization Review and Discharge Planner serve as a liaison between patients, families, referral sources, insurance providers, physicians, and treatment team members to promote positive treatment outcomes and regulatory compliance.

Essential Responsibilities

Utilization Review

• Verify insurance eligibility and benefits for all admissions.
• Obtain and maintain authorizations for inpatient psychiatric treatment.
• Conduct admission, concurrent, and continued-stay reviews with insurance companies.
• Coordinate peer-to-peer reviews between physicians and payors when necessary.
• Submit clinical documentation required for authorization and reimbursement.
• Monitor length of stay and communicate authorization status to treatment team members.

Discharge Planning

• Coordinate comprehensive discharge plans beginning at admission.
• Arrange follow-up appointments, outpatient services, community resources, and referrals.
• Communicate with patients, families, referral sources, and outside providers regarding discharge needs.
• Ensure all discharge documentation and continuing care plans are completed timely.
• Facilitate transfers to appropriate levels of care when indicated.
• Coordinate Level I and Level II screenings as required.

Case Management

• Participate in multidisciplinary treatment team meetings.
• Maintain accurate and timely documentation in the electronic medical record.
• Serve as a liaison between patients, families, physicians, referral sources, and insurance providers.
• Track patient progress and assist in identifying barriers to successful discharge.
• Support quality improvement initiatives and regulatory compliance activities.
• Assist with audits, surveys, and accreditation requirements.

Qualifications

Education

• Bachelor's Degree in Social Work, Psychology, Counseling, Nursing, Human Services, Healthcare Administration, or related field required.
• Master's Degree preferred.

Experience

• Minimum one (1) year experience in case management, discharge planning, utilization review, behavioral health, social services, or healthcare coordination preferred.
• Experience in an inpatient psychiatric or behavioral health setting strongly preferred.

Knowledge, Skills, and Abilities

• Knowledge of behavioral health diagnoses and treatment planning.
• Understanding of insurance authorization and utilization review processes.
• Knowledge of discharge planning and community resource coordination.
• Strong communication, documentation, and organizational skills.
• Ability to work effectively within a multidisciplinary treatment team.
• Proficiency with electronic medical records and Microsoft Office applications.

Certifications

• CPR Certification (or ability to obtain upon hire)
• CPI/Behavioral Management Training (or ability to obtain upon hire)
• Valid Driver's License (if applicable)

Apply Today

Join Freedom Behavioral Hospital and become part of a team dedicated to providing exceptional behavioral healthcare while ensuring patients receive the support and resources needed for successful recovery and continuity of care.

Freedom Behavioral Hospital is an Equal Opportunity Employer.