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CARE MGR - UTILIZATION REVIEW - (21692)

Universal Health Services


Location:
El PASO, TX
Date:
02/16/2018
2018-02-162018-03-17
Job Code:
21692
Universal Health Services
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Job Details

Deltek Talent Management - CARE MGR - UTILIZATION REVIEW - (21692)

Job Details


CARE MGR - UTILIZATION REVIEW - (21692)

Facility Name
EL PASO BEHAVIORAL HEALTH SVCS
Location
El PASO, TX 79902 US (Primary)
Career Area
Professional
Category
Support Staff
Job Description

The Care Manager contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. The Care Manager is responsible for having a thorough understanding of the patient’s treatment through communication with the treatment team.  The Care Manager advocates for the patient’s access to services during treatment team meetings and through individual physician contact.  The Care Manager chairs treatment team meetings and continued stay reviews as indicated. 

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Job Requirements

Education: Bachelor’s or Master’s degree from an accredited college or university in social work, mental health, nursing, or related degree preferred.

Experience:  A minimum of two (2) years experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management

Review the treatment plan and advocate for additional services as indicated.  Promote effective use of resources for patients.  Ensure that patient rights are upheld.  Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team.  Collaborate with the treatment team regarding continued stay and discharge planning issues.  Advocate that the patient is placed in the appropriate level of care and program.  Interface with program staff to facilitate a smooth transition at the time of transfer or discharge.       Maintain documentation related to case management activities.  Assure tracking of insurance reviews, and that reviews are completed in a timely manner.   Maintain statistical reports and prepare documentation of significant findings.  Communicate insurance requirements to all levels of staff.  Provide timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews, and discharges.        Update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial.  Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete.  Provide clinical information to managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days.  Coordinate with the insurance company doctor in appeals process and denials process.

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