What are the responsibilities and job description for the Case Manager, Utilization Review - Mental Health position at WakeMed Health & Hospitals?
The Behavioral Health Case Manager for Utilization Review is responsible for assisting patients and families in recognizing and managing mental health, substance use and psychosocial issues and assists with development of disposition, communication, and execution of discharge plan. Assists with natural support, community, and patient engagement strategies including resource navigation, relapse and prevention planning, referral management, warm handoff communication etc. Functions as a resource and placement specialist for the team with strong working knowledge of MH/SU levels of care. Assists patient with self-management skills, educational materials, advocacy resources, and/or support groups so they can be full participants in their treatment and recovery. Collaborates with the Network for Advanced Behavioral Health for successful connection and patient engagement regarding inpatient placement and outpatient plans. Monitors the referral platform to ensure timely placement and efficient communication. Will conduct safety assessments; arrange transportation, SDOH migration and patient/family education as needed. Anticipates and pro-actively avoids potential delays in disposition. Reviews and assesses appropriateness of patient admission/continued stay. Completes concurrent reviews and monitors the use of insurance benefits to maximize service to patients. Provides timely, pertinent insurance benefits information to clinical staff so that they will provide care within patients? benefits package and thereby optimize third party payment for services. Assists physicians in preparing appeals when payment has been denied by insurance companies. Assists in the implementation of the Hospital Utilization Review Plan. Provides consultation and/or education to clinical staff regarding monitoring studies and medical records reviews. Participates in the preparation and tracking of the Involuntary Commitment processes and represents the hospital in involuntary hearings process.
Department Description:Benefits/Highlights:
- Sign-On Bonus available for select positions
- Competitive Benefits Package
- Tuition Reimbursement
- Public Service Loan Forgiveness
- Free Onsite Parking
Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org.
