Must have previous experience in behavioral health, preferred drug and alcohol.  Attention to details, and a drive to help individuals in their journey.  Team player with knowledge around ASAM. Monday through Friday with one Saturday per month. With travel to our Lancaster facility 2 to 3 days of the week. 

ESSENTIAL FUNCTIONS:

UR

 Act as liaison between managed care organizations and the facility professional clinical staff.  Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.  Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.  Conduct quality reviews for medical necessity and services provided.  Facilitate peer review calls between facility and external organizations.  Initiate and complete the formal appeal process for denied admissions or continued stay.  Assist the admissions department with pre-certifications of care.  Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Case Manager

 Provide case management and care coordination services for clients/patients/residents in the facility. Responsible for coordinating continuum of care activities for assigned clients and ensuring optimum utilization of resources, service delivery, and compliance with external agencies and referral sources requirements. Responsible for psychosocial assessment and for conducting individual, family and group sessions. Conduct various duties related to coordinating treatment and discharge activities, as needed. Provide quality care through developing, implementing, managing and evaluating client/patient care plans. Collect, correlate and provide clinical data to the treatment team. Convey medical criteria and clinical information between the insurance provider and treatment team as warranted. May also correlate clinical data for business office as required. Coordinate in a timely manner, issues or activities relevant to the treatment team.

Benefits:

¨ Medical/Dental/Vision insurance

¨ Flexible Spending Accounts and Healthcare Savings Accounts

¨ Company paid basic life insurance and AD&D

¨ Supplemental life insurance and AD&D

¨ 401K (with match)

THE ABILITY TO SAVE SOMEONES LIFE!