Behavioral Health – Case Manager

Education

Masters Degree Counseling or Social Work Required

Experience

3 Years Clinical psychiatric or chemical dependency experience Required and

6 Months in case management or utilization review Required

Prior experience with EPIC EMR

Licenses and Certifications

LMSW - Licensed Master Social Worker Upon Hire Required Or

LCSW - Licensed Clinical Social Worker Upon Hire Required Or

LPC - Licensed Professional Counselor Upon Hire Required Or

LPC-A - Licensed Professional Counselor Associate Upon Hire Required Or

CPR - Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required And

ACPI - Advanced Crisis Prevention Intervention Training Upon Hire Preferred

What You Will Do

Daily Payor and Chart Review Activities
Identifies those cases requiring certification or re-certification for third party payors. Ensures reviews are initiated on all patients; conducts reviews on admission continued stay and discharge as defined in behavioral health policies.
Reviews the treatment plan and advocate for additional services as indicated.
Consults with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete.
Reviews records of patients according to approved criteria. Verifies appropriateness of the admission continued stay and concurrence with government/third party payor regulations. Documents all actions per required processes. Notifies supervisor if patient is not meeting criteria.
Refers cases that do not meet criteria to supervisor attending physician and other members of the treatment team as appropriate.
Records are maintained for all reviews completed. This will include documenting all activity with the third-party payor and notes the number of certified days dates of contact authorization codes and reference numbers for approval/disapproval.
Ensures the appropriateness of hospitalization or continued hospitalization in accordance with approved criteria.
Records of criteria and correspondence with external agencies and insurance companies are maintained for reference.

Treatment Team Coordination
Attends multidisciplinary treatment team.
Maintain ongoing contact with the attending physician program manager nurse manager and various members of the treatment team.
Provides timely feedback to the attending physician and treatment team members concerning continuing certification of days/service
Collaborates with the treatment team and supervisor regarding continued stay and discharge planning issues.
Ensures coordination of benefits regarding continuity of care decisions.
Recommends and promotes discharge planning activities that reflect patient medical necessity needs and third-party payor authorization.
Coordinates discharge planning as needed between the third-party payor and discharge planner(s).
Maintains current awareness of mental health activities in the community.
Maintains an awareness of community and market-related activities which includes knowledge of the activities of other providers needs of local payors and the political climate related to mental health.
Remain current on all clinical techniques and age-related mental health competencies and provide direction to staff and facility personnel as needed.
Committees
Attends other hospital committees task force meetings and participates in Continuous Improvement (CI) teams as assigned.
Effectiveness and quality of the services provided by the organization are enhanced.
Utilization management issues are identified and addressed by the appropriate individuals/committees

Compliance and Patient Advocacy
Maintains current knowledge of Medicare federal and state regulatory requirements for documentation record keeping and patient rights.
Any observed deficiencies in Medicare federal and state regulatory requirements are reported to supervisor and Administrative leaders as appropriate.
Potential utilization management issues are addressed with supervisor and administration leaders as necessary to ensure the most appropriate use of the hospitals resources.
The admission and continued hospitalization of third-party payor patients are appropriate and authorized.
Recognizes and communicates ethical and legal concerns through established channels of communication.
Action taken to protect patient rights and/or preferences and promote patient desired outcomes.
Patient advocacy role demonstrated and documented when appropriate.
Maintains confidentiality of facility employees and patient information

Professional Standards
Provides and accepts constructive feedback in a calm respectful manner.
Code White HIPAA BLS/CPR 1 hour each adolescent/adult/geriatric age-specific training ethics training
Care Connect updates and training and continuing education required for license completed annually
Education record maintained.
Treats all staff courteously.
Maintains professional accountability.
Complies with personnel policies i.e. Attendance Policy Dress Code Social Work Practice Act etc.
Licensure and certifications maintained as required.
Takes responsibility to manage time and resources.
Utilizes professional judgement to consistently prioritize daily workflow
Adapts to changes in workload by demonstrating flexibility in UR needs.
Coordinates efficient communications with payor and customer stakeholders
Complies with reimbursement related standards
Identifies ineffective and costly processes and provides suggestions for improvement
Utilizes resources cost effectively

Denials and Appeals
Reviews denial work queues and denial documentation activities on a routine basis
All denied behavioral health claims are reviewed and appealed when appropriate to third-party payors.
Maintains current knowledge of appeal policies and procedures for third party payors.
Documents ongoing efforts to resolve unpaid claims.
Coordinates with the insurance company physicians in appeals expedited appeals or denial process as necessary.
Maintains ongoing contact and collaboration with the CBO billing and coding departments.

Additional perks of being a Texas Health employee:

Benefits include 401k PTO medical dental Paid Parental Leave flex spending tuition reimbursement Student Loan Repayment Program as well as several other benefits.

At Texas Health our people make this a great place to work every day. Our inclusive supportive people-first excellence-driven culture make us a great place to work.

A supportive team environment with outstanding opportunities for growth.

Explore ourTexas Health careers sitefor info likeBenefitsJob Listings by Category recentAwardsweve won and more.

Do you still have questions or concernsFeel free to email your questions to.

Behavioral Health Case Manager

Bring your passion to THR so we are Better Together

Work location:Texas Health Resources Behavioral Health Remote

Work hours:Full-time (40hours) Monday Friday 9:00AM 5:00PM