What are the responsibilities and job description for the Lead Utilization Review Case Manager position at HARMONY FOUNDATION INC?
Primary Function: Responsible for communication of clinical information with third-party payers to obtain appropriate and timely authorization of care for clients.
Essential Functions:
- Collects, reviews, and presents clinical information to obtain authorization of care.
- Assist AllHealth with their commercial division and review walk in clinic.
- Educate staff on the process for Medicaid acceptance.
- Performs case reviews and documents outcomes in client record and department workflow sheet utilizing dedicated software
- Collects data from counseling and nursing staff to provide quality of care reviews.
- Performs admission pre-certification within 24-48 hours of admission.
- Maintain a caseload of 25-30 clients across all levels of care.
- Completes all case management including pre-certification, continued stay review, and Level I reviews in a timely fashion.
- Completes all documentation, including electronic medical record, UR Flow Sheet and CSR Sheet in a timely manner.
- Adheres to confidentiality laws including 42CFR Part 2, HIPAA and HITECH as well as all Harmony policies and procedures.
- Coach, mentor and lead other utilization review team members.
