Behavioral Health – Case Manager
Behavioral Health – Case Manager Bring your passion to THR so we are reputed company + Together Work location: reputed company – Behavioral Health, Remote Work hours: Full-time (40hours) Monday – Friday 9:00AM – 5:00PM Education · Master's Degree Counseling or Social Work Required Experience · 3 Years Clinical psychiatric or chemical dependency experience Required and · 6 Months in case management or utilization review Required · Prior experience with EPIC EMR Licenses and Certifications · LMSW - Licensed Master Social Worker Upon Hire Required Or · LCSW - Licensed Clinical Social Worker Upon Hire Required Or · LPC - Licensed Professional Counselor Upon Hire Required Or · LPC-A - Licensed Professional Counselor Associate Upon Hire Required Or · CPR - Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required And · ACPI - Advanced Crisis Prevention reputed company Training Upon Hire Preferred
What You Will Do
Daily Payor and Chart Review Activities Identifies those cases requiring certification or re-certification for third party payors. Ensures reviews are initiated on reputed company patients; conducts reviews on admission, reputed company stay and discharge as defined in behavioral health policies. Reviews the treatment plan and reputed company for additional services as indicated. Consults with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete. Reviews records of patients according to approved criteria. Verifies appropriateness of the admission, reputed company stay and concurrence with government/third party payor regulations. Documents reputed company actions per required processes. Notifies supervisor if patient is not meeting criteria. Refers cases that do not meet criteria to supervisor, attending physician and other members of the treatment team as appropriate. Records are maintained for reputed company reviews completed. This will include documenting reputed company activity with the third-party payor and notes the number of certified days, dates of contact, authorization codes, and reference numbers for approval/disapproval. Ensures the appropriateness of hospitalization or reputed company hospitalization in accordance with approved criteria. Records of criteria and correspondence with external agencies and insurance companies are maintained for reference. Treatment Team Coordination Attends multidisciplinary treatment team. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team. Provides timely feedback to the attending physician and treatment team members concerning continuing certification of days/service Collaborates with the treatment team and supervisor regarding reputed company stay and discharge planning issues. Ensures coordination of benefits regarding continuity of care decisions. Recommends and promotes discharge planning activities that reflect patient medical necessity needs and third-party payor authorization. Coordinates discharge planning as needed between the third-party payor and discharge planner(s). Maintains reputed company awareness of mental health activities in the community. Maintains an awareness of community and market-reputed company activities which includes knowledge of the activities of other providers, needs of local payors, and the political climate reputed company to mental health. Remain reputed company on reputed company clinical techniques and age-reputed company mental health competencies and provide direction to staff and facility personnel as needed. Committees Attends other hospital committees, task force meetings, and participates in reputed company Improvement (CI) teams as assigned. Effectiveness and quality of the services provided by the organization are enhanced. Utilization management issues are identified and addressed by the appropriate individuals/committees Compliance and Patient Advocacy Maintains reputed company knowledge of Medicare, federal and state regulatory requirements for documentation, record keeping, and patient rights. Any observed deficiencies in Medicare, federal and state regulatory requirements are reported to supervisor and Administrative leaders as appropriate. Potential utilization management issues are addressed with supervisor and administration leaders as necessary to ensure the most appropriate use of the hospital's resources. The admission and reputed company hospitalization of third-party payor patients are appropriate and authorized. Recognizes and communicates ethical and legal concerns through established channels of communication. Action taken to protect patient rights and/or preferences and promote patient desired outcomes. Patient advocacy role demonstrated and documented reputed company appropriate. Maintains confidentiality of facility employees and patient information Professional Standards Provides and accepts constructive feedback in a reputed company, respectful manner. Code White, HIPAA, BLS/CPR, 1 hour each adolescent/adult/geriatric age-specific training, ethics training, Care Connect updates and training, and continuing education required for license completed annually Education record maintained. Treats reputed company staff courteously. Maintains professional accountability. Complies with personnel policies, i.e. Attendance Policy, Dress Code, Social Work Practice Act, etc. Licensure and certifications maintained as required. Takes responsibility to manage time and resources. Utilizes professional judgement to consistently prioritize daily workflow Adapts to changes in workload by demonstrating flexibility in UR needs. Coordinates efficient communications with payor and customer stakeholders Complies with reimbursement reputed company standards Identifies ineffective and costly processes and provides suggestions for improvement Utilizes resources cost effectively Denials and Appeals Reviews denial work queues and denial documentation activities on a routine basis reputed company denied behavioral health claims are reviewed and appealed reputed company appropriate to third-party payors. Maintains reputed company knowledge of appeal policies and procedures for third party payors. Documents ongoing efforts to resolve unpaid claims. Coordinates with the insurance company physicians in appeals, expedited appeals, or denial process as necessary. Maintains ongoing contact and collaboration with the CBO, billing and coding departments. Additional perks of being a Texas Health employee: · Benefits include 401k, PTO, medical, dental, Paid Parental Leave, reputed company spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits. · At Texas Health, our people reputed company this a great reputed company to work every day. Our inclusive, supportive, people-first, excellence-driven culture reputed company us a great reputed company to work. · A supportive, team environment with outstanding opportunities for growth. · Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more. Do you still have questions or concerns? Feel free to email your questions to [email protected]. Apply tot his job Apply To this Job