Case Manager job in Mental Health field
Senior Review Coordinator – Case Manager
As a Senior Review Coordinator, you will be responsible for conducting utilization review, level of care determination, and medical management for our Home and Community-Based Children’s mental health waiver, Psychiatric Medical Institutions for Children (PMIC), inpatient psychiatric hospitalization, and case management.
As part of our commitment to health and safety, COVID-19 vaccines are required for all newly hired employees and contractors.
- You will conduct level of care reviews for Children’s Mental Health (CMH) waiver, Psychiatric Medical Institution for Children (PMIC), and Inpatient Psychiatric (IPP) hospital services.
- You will perform prospective, concurrent, and retrospective level of care reviews/medical management ensuring quality of care based on contract, state, or URAC requirements by utilizing specific criteria to determine if care is appropriate.
- You will coordinate the appeal process by writing appeal summaries and participating in the appeal process
- You will refer cases that fail to meet specific criteria to physician review.
- You may provide technical assistance, medical record review, and support to provider staff and physician reviewers.
- You may coordinate and participate in peer-to-peer reviews.
- You will serve as a liaison between peer review, provider, facility, and/or member.
50 %-Case Management (Idaho): Focus on care coordination efforts with pediatric cases receiving behavioral health services which may include:
- Conducting telephonic assessments
- Creating comprehensive care plans
- Referral to appropriate community resources
- Monitoring of progress
- Collaborating with health care providers among different agencies, provider types, and ancillary service providers to create or validate the treatment plan
- Be actively involved in treatment team meetings and staffing meetings
- Providing ongoing monitoring of each case
- Evaluating treatment adherence
- Evaluating the participant’s commitment to making necessary changes