The purpose of this position is to assess medical necessity, conduct pre-authorizations and concurrent reviews with insurance providers.
Manage inpatient pre-authorizations for psychiatric and chemical dependency patients as needed.
Manage inpatient concurrent reviews for psychiatric and chemical dependency patients.
Proven experience in conceptualizing a case, and creating a clinical impression to present to all insurance providers.
Read and interpret patient's case notes.
Clearly and concisely be able to document patient outcomes.
Coordinate peer to peer process as needed.
Establish and maintain positive effective communication (verbally and in writing) with insurance providers and internal staff.
Collect patient clinical data and be able to effectively communicate it to insurance providers and internal staff.
Develop a partnership with insurance providers and internal departments to effectively resolve patient issues.
Maintain professional relationship with insurance providers and internal staff.
Communicate in a timely manner any concerns regarding patients continued stay criteria to insurance providers and internal staff.
Perform other functions and tasks as assigned
Bachelor's degree in Social Work, Counseling or related Human Service field required. One or more years of experience working in behavioral health setting. Experience with the patient population served by the facility preferred. Previous experience in case management and/or utilization review preferred.