Utilization Review Case Mgr Non-RN
St. Luke’s Behavioral Health Center is a 127-bed facility located in the heart of Phoenix, Arizona. The Behavioral Health Center offers a full spectrum of inpatient and outpatient services for seniors, adults, adolescents, and children requiring psychiatric and chemical dependency care
Position Title: Utilization Review Case Mgr Non-RN (PRN)
- Validates the medical necessity of admission and ongoing services of patients at St. Luke’s Behavioral Health Center and verifies or obtains authorization from third party payers.
- Utilizes InterQual criteria for admission and continued stay reviews.
- Continuously collects data about the behavioral healthcare status of the patient systematically to determine the need and type of care and treatment to be provided, and the need for further assessment.
- Identifies various levels of treatment available for the patient and works closely with the multidisciplinary team to coordinate/evaluate continued care and services and also advocate for appropriate discharge planning (including next level of care). Obtains authorization for next level of treatment when appropriate.
- Identifies St. Luke’s Behavioral Health Programs, individual providers and community resources, and documents options in medical record.
- She/he is accountable to problem-solve for the care of the patient and to initiate immediate, effective action to maintain patient safety.
- Responsible to meet Medicare/Medicaid regulatory requirements related to the provision of services for inpatient and outpatient mental health treatment.
- Follows all safety and infection prevention guidelines.
- Implements hospital policies established by St. Luke’s Behavioral Health Center.
- Keeps director and management apprised of administrative and clinical issues.
- Demonstrates leadership skills oriented towards quality care delivered efficiently with appropriate utilization contributing to the overall smooth operation of the department and organization.
- Participates in performance improvement activities.
- Demonstrates an ability to be flexible, organized and function under stressful/emergency situations.
- Performs related duties as directed by the Director of Case Management.
- Master’s degree preferred from an accredited University in behavioral health field with 2 years behavioral health experience. Bachelor’s Degree Required with 2 years behavioral health experience.
- Previous work in Utilization Management/Utilization Review working with Medicare and Medicaid payor sources is highly recommended.
- Certified Case Manager (CCM) and 2 years behavioral health experience is also acceptable.