Utilization Review Case Manager - Partial Hospitalization Program
Luminis HealthLanham, Maryland, United States · Posted 9 days agoDescription
<p><strong>Luminis Health</strong></p><p>Title:&nbsp; Utilization Review/Case Manager-Partial Hospitalization Program &nbsp;&nbsp;</p><p>Department:&nbsp; Lanham Partial Hospitalization</p><p>Reports To:&nbsp; Director- Clinical Director Behavioral Health Lanham</p><p>Cost Center/Job Code:&nbsp; 41000-42002-001148</p><p>FLSA Status: Exempt</p><p><strong>Position Objective:</strong></p><p>Performs and monitors integrated, concurrent utilization review and case referrals on patients, consistent with the approved Utilization Review Plans. Works with medical and professional staff to obtain appropriate clinical documentation for review and optimal patient placement. Maintains contact with Managed Care and other third party payors to assure appropriate case management.</p><p><strong>Essential Job Duties:</strong></p><p>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions</p><ol type="1"><li>Performs duties according to established standards for age groups adolescence through geriatric.</li><li>Assesses data reflective of the patients status and interprets the appropriate information needed to identify each patients requirements relative to his or her age-specific needs.&nbsp; Maintains monthly statistical data and reports data to Clinical Director.</li><li>Identifies status of physical, social and psychological needs of the patient, family and significant others.</li><li>Evaluates data obtained in the bio-psychosocial and nursing history and assesses patients and their families to determine by interview, appropriateness for admission or referral.</li><li>Determines the medical necessity and appropriateness of admission, using established criteria and standards.</li><li>Verifies that pre-admission assessment is performed, and pre-authorizes patients as applicable.</li><li>Monitors medical records for medical necessity and appropriateness of continued stay in accordance with established and approved norms.</li><li>Verifies prior authorization data and performs concurrent reviews with external review agents on a daily basis in order to provide medical necessity and intensity of service information for continued stay approvals.</li><li>Consolidates, tracks and reports performance on completed utilization review forms for all clinical areas and relays information to the multi-disciplinary treatment team.</li><li>Resolves matters on outliers and initiates/follows up on appeals for determination at variance with program norm.</li></ol><p><strong>Educational/Experience Requirements:</strong></p><ul type="disc"><li>BA/BS</li><li>Two years of experience performing utilization review or utilization management.&nbsp;</li></ul><p><strong>RequiredLicense/Certifications:</strong></p><p><strong>Working Conditions, Equipment, Physical Demands:</strong></p><p>There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.</p><p>Physical Demands -</p><p><strong><sub>Light work.</sub></strong><sub>&nbsp;Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.</sub></p><p><strong>The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.</strong></p><p>The above job description is an overview of the functions and requirements for this position.&nbsp; This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.</p><div class="content-pay-transparency"><div class="pay-input"><div class="title">Pay Range</div><div class="pay-range"><span>$81,967.12</span><span class="divider">&mdash;</span><span>$122,950.68 USD</span></div></div></div><div class="content-conclusion"><p><span style="text-decoration: underline;"><strong>Luminis Health Benefits Overview:<br></strong></span>• &nbsp; &nbsp;Medical, Dental, and Vision Insurance<br>• &nbsp; &nbsp;Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)<br>• &nbsp; &nbsp;Paid Time Off<br>• &nbsp; &nbsp;Tuition Assistance Benefits<br>• &nbsp; &nbsp;Employee Referral Bonus Program<br>• &nbsp; &nbsp;Paid Holidays, Disability, and Life/AD&amp;D for full-time employees<br>• &nbsp; &nbsp;Wellness Programs<br>• &nbsp; &nbsp;Employee Assistance Programs and more<br>*Benefit offerings based on employment status</p> <p><span style="text-decoration: underline;"><strong>Opt-in for text notifications!<br></strong></span>Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone.<br><br>To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time.&nbsp;<strong><br></strong><em>Standard text messaging rates may apply based on the candidate's mobile carrier plan. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges.</em></p> <p><span style="text-decoration: underline;"><strong><br><br></strong></span></p> <p>&nbsp;</p> <p>&nbsp;</p></div>
Similar jobs
Est. 102,459 USD
Luminis HealthTitle: Utilization Review/Case Manager - Partial Hospitalization ProgramDepartment: Lanham Partial HospitalizationReports To: Director - Clinical Director Behavioral Health LanhamCost Center/Job Code: 41000…
Est. 49,408 USD
<p style="color: #000000; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-style: normal; font-weight: 400;"><strong><span style="text-decoration: underline">Position Objective:&l…
Est. 44,796 USD
<p style="color: #000000; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-style: normal; font-weight: 400;"><strong><span style="text-decoration: underline">Position Objective:&l…
Est. 23,795 USD
<p style="color: #000000; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-style: normal; font-weight: 400;"><strong><span style="text-decoration: underline">Position Objective:&l…
Est. 22,000 USD
<p><strong>Position Objective:</strong></p><p>Provides support to the technical staff in the delivery of medical laboratory information related to diagnosis, treatment, and prevention of dis…
Est. 41,500 USD
<p style="color: #000000; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-style: normal; font-weight: 400;"><strong><span style="text-decoration: underline">Position Objective:&l…
Est. 46,896 USD
<p>&nbsp;</p><p><strong>Position Objective:</strong></p><p><strong>Advanced Medical Assistant </strong></p><p>The Advanced Medical Assistant is an ess…
Est. 50,000 USD
<p><strong>Position Objective:</strong></p><p>Contributes to the provision of high-quality, cost-effective healthcare as a provider of direct and indirect patient care and by effective of th…
Est. 50,000 USD
<p><strong>Position Objective:</strong></p><p>Contributes to the provision of high-quality, cost-effective healthcare as a provider of direct and indirect patient care and by effective of th…
Est. 77,624 USD
<p>&nbsp;</p><p><strong>Position Objective:</strong></p><p>Responsible for carrying out Clinical Pharmacy services through promoting evidence-based pharmacotherapy and sound…
Est. 88,400 USD
Position ObjectiveThe Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across…
Est. 88,400 USD
Position ObjectiveThe Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across…
Est. 42,101 USD
<p class="MsoNoSpacing"><strong><span style="font-family: 'Arial',sans-serif">Position Objective:</span></strong></p><p class="MsoNoSpacing">Provides information for diagnosis, t…
Est. 88,400 USD
Position ObjectiveThe Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across…
Est. 88,400 USD
Position ObjectiveThe Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across…
Est. 40,000 USD
<p><strong>Position Objective:</strong></p><p>The Anestheisa Technologist will report to the Anesthesia Team Coordinator and Team Lead under the supervision of the unit Clinical Director.<…
Est. 12,710,590 USD
<p><strong>Position Objective:</strong></p><p>Leads and coordinates the short and long-term operations of the designated laboratory area.</p><p><strong>Essential Job Duties…
Est. 88,400 USD
Position ObjectiveThe Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across…
Est. 92,560 USD
Position ObjectiveConducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of paymen…
Est. 25,500 USD
<p><strong>Position Objective:</strong></p><p>Under the direct supervision of a Maryland-licensed pharmacist and in coordination with other technicians, the Pharmacy Technician performs vari…
Est. 41,558 USD
Position PurposeTo process patients through the admission procedures as quickly as possible while collecting complete and accurate personal, clinical and financial information. The information, which should be gathered i…
Est. 41,558 USD
Position PurposeTo process patients through the admission procedures as quickly as possible while collecting complete and accurate personal, clinical and financial information. The information, which should be gathered i…
Est. 92,560 USD
Position ObjectiveConducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of paymen…
Est. 50,310 USD
Position ObjectiveResponsible for the day-to-day administration of the hospitalist program for more than one practice. Serve as the liaison between the Practice Manager, Hospitalist Supervisor of the program, individual…
Est. 22,500 USD
<p><strong>Patient Care Technician Trainee</strong></p><p><strong>Position Objective:<br></strong>Provides direct care to patients with special attention to personal hygien…
Est. 47,840 USD
Position ObjectiveMedical Assistants perform a variety of administrative and clinical tasks to help provide care to patients, support providers, and keep office operations running smoothly.Essential Job DutiesReasonable…
Est. 100,100 USD
Position ObjectiveProvides psychosocial assessment, individual, family and group therapy to case load of patients. Assessments, plans for and implements identified services for patients. Works with the patient and family…
Est. 55,120 USD
Luminis HealthTitle: Unit Resource Coordinator (URC)Job Code: 002055FLSA Status: Non-ExemptPosition ObjectiveThe Unit Resource Coordinator is responsible for the maintenance of patient medical records, communication inte…
Est. 90,000 USD
Position ObjectiveThe Licensed Clinician will work in tandem with the primary care team and is responsible for providing brief intervention and consultation to patients in an outpatient setting. Services to include: cris…
Est. 90,000 USD
Position ObjectiveThe Licensed Clinician will work in tandem with the primary care team and is responsible for providing brief intervention and consultation to patients in an outpatient setting. Services to include: cris…