Center for Discovery

  • Utilization Review Case Manager

    Job Locations US-NJ-Medford
    Posted Date 3 weeks ago(3 weeks ago)
    Job ID
    2018-2991
    # of Openings
    1
    Category
    Other
    Job Type
    Regular Full-Time
  • Overview

    About Discovery Behavioral Health 

    Discovery Behavioral Health has a 20-year legacy of transforming lives by promoting health, healing and hope to our clients and their families.  We are a national leader in behavioral healthcare and offer world-class treatment for eating disorders, mental health and substance abuse conditions.  We serve adolescents and adults in both residential and outpatient settings. It is our mission to create a transformative therapeutic experience aimed at profoundly and creatively facilitating behavioral, emotional and spiritual growth. We place a high priority on providing an environment that supports an unlimited capacity for learning, and we seek qualified individuals who share our passion for improving the lives of those we serve.

     

    Benefits of Working at Discovery Behavioral Health

    At Discovery Behavioral Health you will have the opportunity to work closely within a team of professionals consisting of eating disorder and mental health experts, all dedicated to promoting lasting health and healing.  Clinical supervision and guidance are provided on total client care and therapeutic milieu management, as well as career growth and personal development oversight. You will develop an individualized growth plan which will help you develop your professional skills and career objectives.

     

    Additional benefits include:

    • Full medical, dental, vision, life, disability and supplemental benefits including FSA and 401K
    • Paid sick time, vacation days and paid holidays
    • Team-building exercises and activities
    • A fun, dynamic setting including weekly company-sponsored lunches
    • Monthly birthday celebrations, ample snacks provided
    • Annual BBQ company event and holiday party

    The Position

    The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, Operations, Admissions and Clinical Outreach teams to maximize our ability to provide an appropriate and fully funded length of stay to each client. The Utilization Review Case Manager is responsible for overseeing all processes related to insurance authorization of Discovery Behavioral Health clients. This position will be working directly with one of our Drug & Alcohol treatment programs in Medford, NJ. 

    Qualifications

    • Licensed LMFT, LCSW, LPC, LVN, or RN
    • Extensive knowledge of the treatment of mental health disorders and substance abuse in children, adolescents and adults.
    • An in-depth understanding of levels of care and relevant criteria.
    • Current or past experience in providing utilization review, insurance authorization and an ability to advocate strongly for clients to receive appropriate levels of care.
    • Strong writing skills and experience in preparing formal written appeals.
    • Familiarity with the managed care system, benefit eligibility and appeals processes.
    • A working understanding of medical complications associated with eating disorders, mental illness and substance abuse and the ability to articulate medical necessity at all levels of care.
    • Record keeping must be accurate and thorough.
    • An advanced degree and/or certification in mental health or nursing related field.

    Responsibilities

    • Daily tracking and reporting of authorization status for all clients to assure that there are no unauthorized days as it pertains to insurance.
    • Train and mentor all Discovery Behavioral Health clinicians and interns on a regular basis to assure consistently high levels of ability in presenting relevant criteria to insurance companies during the standard UR process.
    • Oversee all higher- level appeals in conjunction with Director of Operations.
    • Regularly audit clinical records to assure high quality documentation that supports good insurance authorization outcomes.
    • Understanding DSM V diagnosis; ICD 10 codes and ASAM criteria and dimensions for all levels of care
    • Communicate closely with Discovery Behavioral Health psychiatrists to support peer- to- peer reviews and to maintain awareness of strength of criteria that might support higher level appeals.
    • Maintain close communication with the business office to minimize any unfunded treatment days and to assist with obtaining parent contracts.

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