Archer Administration Psychiatric Case Manager (Utilization Review)

DESCRIPTION OF POSITION:

• The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.

RESPONSIBILITIES AND DUTIES:

• Prepares information for notification letters for providers and employees.
• Performs utilization review in accordance with all state mandated regulations.
• Maintains compliance with regulation changes affecting utilization management.
• Performs continuing review on medical records and identification and need of on-going hospitalization.
• Reviews patients' records and evaluates patient progress.
• Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review.
• Reviews and validates physician's orders, reports progress and unusual occurrences on patients.
• Receives & processes requests for appeal of denials.
• Attends required meetings regarding approvals, denials, pre-certs, authorizations and retro reviews.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• Degree in Social Services, Psychology or related filed; LPN/RN licensure preferred
• Minimal 5-7 Years Experience working with mentally ill &/or addictions
• Louisiana Nursing License or multi-state compact nursing license, Crisis Response Training, CPR
• Ability to communicate with patient, family, peers and medical personnel.
• Requires emotional stability and resilience.
• Must be adaptable to change, be decisive, and demonstrate foresight.
• Exhibits organizational and leadership ability.
• Shows ability to gain and maintain support and respect.

Physical Demands/Work Environment

• Work requires a variety of physical activities including sitting, standing and walking.
• Bending, stooping, and lifting are minimal.
• The work environment may be physically confining.
• Visual acuity required for a variety of activities.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.