Behavioral Health/Utilization Review Case Manager (RN, LPC, LCSW)-Bedford, TX

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Summary. Responsible for responding to an authorization request by obtaining clinical information, reviewing the clinical provided, and meeting evidence-based criteria. Responsible for preparing for medical director review when criteria is not met. Responsible for documenting required information in the UM documentation system. Responsible for researching other documentation systems as needed. Responsible for keeping the service coordinator apprised of member status upon admission and discharge. Participates in the discharge planning process and identifies appropriate resources both internal and external required for a successful transition of care to an alternative setting. Principle Accountabilities - Responsible for the effective and sufficient support of all utilization activities according to policies and procedures. Refers cases to the Medical Director as appropriate. Evaluates and refers cases to the quality of care and chronic case improvement programs as needed. Assists with discharge planning. Maintains strong working relationship with internal and external customers and professionally communicates information as needed or required. Documents information into the computer system. Provides leadership to other team members. Serves as a preceptor for new employees.. Participates in process improvement teams and serves as a subject matter expert in developing and implementing process changes. Compliant with turnaround times and maintains unit goals. Follows Texas Medicaid benefit structure for coverage of services. Willingness to learn new information.