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.

    Typical hours will be 8:00 am to 4:30 pm Central Time

    What You’ll Do:

  • 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