Utilization Review Case Manager

This position is on‑site and NOT a remote position.

Responsibilities

• Work with insurance companies and managed care systems for authorization, concurrent, and retrospective review of inpatient admissions and services.
• Obtain authorization for each admitted patient.
• Review and monitor each step of the authorization process to proactively identify potential problems and help patients access the full range of their benefits.
• Conduct admission reviews.
• Conduct concurrent and extended stay reviews.
• Prepare and submit appeals to third‑party payors.
• Maintain appropriate records of the Utilization Review Department.
• Perform related duties as requested.
• Uphold the organization’s ethics and customer service standards.

Requirements

• Education: Clinical degree such as nursing, social work, psychology, health information management, or other related healthcare field (preferred) or related experience.
• Licenses: RN or LVN license preferred.
• Experience: Two years clinical experience in a facility with medical terminology and criteria for acute psychiatric care, or a combination of education and experience.

Knowledge, Skills & Abilities

• Flexibility, attention to detail, ability to multi‑task and prioritize with strong time‑management skills.
• Responsiveness to deadlines, assertiveness, persistence, persuasiveness, and ability to work with minimal direction or supervision.
• Knowledge of managed‑care environment; ability to apply and interpret admission and continued‑stay criteria.
• Understanding of admission and discharge functions; familiarity with medical terminology, diagnostic terms, and treatment modalities.
• Knowledge of medical record keeping; strong interpersonal, organizational, evaluative, and policy‑interpretation skills.
• Familiarity with applicable standards and regulations.
• Ability to comprehend psychiatric evaluations, consults, lab results, etc.

Physical Demands

• Ability to stoop, kneel, crouch, reach, stand for sustained periods, walk, pull, lift, raise and move objects up to 50 lb (with or without reasonable accommodations).
• Finger grasp; ability to feel sizes, shapes, temperatures, and textures.
• Oral communication, potentially loudly, accurately, or quickly.
• Visual abilities to detect, determine, perceive, identify, recognize, judge, observe, inspect, and assess.
• Auditory ability to perceive sound with or without correction.
• Perform repetitive motions of the wrist, hands, or fingers.

Benefits

• Medical, dental, and vision coverage.
• Company‑paid disability insurance.
• 401(k) retirement plan.
• Generous paid time off.