Utilization Review Case Manager - Partial Hospitalization Program

The role

This person will perform utilization review and case management for patients in the Lanham Partial Hospitalization program. The work covers medical necessity reviews, authorizations, and coordination with the clinical team and payors.

What you will do

• Perform concurrent utilization review and case referrals consistent with approved Utilization Review Plans
• Assess patient status and needs for patients and families across adolescence through geriatric age groups
• Determine medical necessity and appropriateness of admission using established criteria
• Verify pre-admission assessments and pre-authorize patients as applicable
• Monitor medical records for continued stay approval
• Verify prior authorization data and perform daily concurrent reviews with external review agents
• Track and report utilization review performance and relay information to the multi-disciplinary treatment team
• Resolve outlier matters and initiate and follow up on appeals
• Maintain contact with Managed Care and other third party payors
• Maintain monthly statistical data and report to the Clinical Director

Required qualifications

• BA/BS degree

Nice to have

• Two years of experience performing utilization review or utilization management

Benefits

• Medical, dental, and vision insurance
• Retirement plan with employer match for employees who work more than 1000 hours in a calendar year
• Paid time off
• Tuition assistance
• Employee referral bonus program
• Paid holidays, disability, and life/AD&D for full-time employees
• Wellness programs
• Employee assistance programs

Before you apply

• Opting in to SMS text notifications from recruiters is offered during application; standard carrier rates may apply

About the company

Luminis Health is the employer for this role, which supports its Behavioral Health services in Lanham.