Psychiatric Case Manager

Description of Position

The Psychiatric Case Manager supervises day-to-day functions of the department and staff. The manager actively seeks areas for the department to improve (i.e., reduction in denials) and/or be more efficient.

Supervision

Reports directly to Director of Psychiatric Services

Responsibilities and Duties

• Prepares information for notification letters for providers and employees.
• Performs utilization review in accordance with all state mandated regulations.
• Maintains compliance with regulation changes affecting utilization management.
• Performs continuing review on medical records and identifies and needs of on-going hospitalization.
• Reviews patients' records and evaluates patient progress.
• Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review.
• Reviews and validates physician's orders, reports progress and unusual occurrences on patients.
• Receives & processes requests for appeal of denials.
• Attends required meetings regarding approvals, denials, pre-certs, authorizations and retro reviews.

Educational and Work Experience

• Bachelor’s Degree (BA) required, Social Work preferred OR Nursing Certification with RN preferred
• Minimal 3-5 Years Experience working with mentally ill &/or addictions required
• Louisiana Nursing License or multi-state compact nursing license preferred, Crisis Response Training, CPR
• Ability to communicate with patient, family, peers and medical personnel.
• Requires emotional stability and resilience.
• Must be adaptable to change, be decisive, and demonstrate foresight.
• Exhibits organizational and leadership ability.
• Shows ability to gain and maintain support and respect.

Physical Demands/Work Environment

• Work requires a variety of physical activities including sitting, standing and walking.
• Bending, stooping, and lifting are minimal.
• The work environment may be physically confining.
• Visual acuity required for a variety of activities.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.