What are the responsibilities and job description for the Case Manager position at Psychiatric Medical Care?
Description
Case Manager- Inpatient Behavioral Health
Salary: $32/hour - $48/hour (Dependent upon experience)
Hours: Mon-Fri. No weekends on on-call.
Location: Albuquerque, TX (onsite)
Who we are:
Psychiatric Medical Care is one of the county's largest Behavioral Health Management companies. Why work with PMC? Because PMC works for you. At PMC, we strive to maintain a culture of kindness and accountability. We embrace diversity and inclusion and provide team member support. We encourage everyone at PMC to have a healthy work-life balance and bring their authentic selves to work every day.
Competitive Benefits:
- Free Dental & Free Vision
- Practically Free Medical Starting As Low As $20/Month
- Matching 401k
- Furthering Education Assistance
- Employee Rewards, Assistance, & Referral Bonus Program
Essential Duties & Responsibilities
Utilization Review & Case Management
- Conducts reviews of patient admissions and continued hospital stays to ensure medical necessity.
- Identifies patients needing case management through admissions screening, chart review, and discharge planning meetings.
- Performs case management assessments and collaborates with interdisciplinary teams for discharge planning.
- Provides guidance to hospital staff regarding regulatory requirements, reimbursement policies, and utilization guidelines.
- Reviews observation admissions twice daily to determine appropriate utilization of services.
- Coordinates with the physician advisor on cases that do not meet acute care criteria.
- Ensures timely documentation and submission of third-party payer reviews and medical necessity determinations.
Patient & Staff Education
- Educates patients, families, and healthcare providers on the medical necessity process and regulatory requirements.
- Assists physicians in ensuring complete documentation of patient severity and required services.
- Clarifies treatment plans and collaborates with attending physicians to support appropriate care decisions.
Discharge Planning & Coordination
- Identifies potential delays in care and refers cases to the appropriate department or physician.
- Ensures referrals are completed for patient discharge needs, including home health, skilled nursing, DME, and social services.
- Coordinates incoming patient transfers and facilitates outgoing transfers when appropriate.
- Prepares cases for physician advisor review, ensuring proper documentation and clear presentation of concerns.
Regulatory Compliance & Quality Improvement
- Keeps current with regulatory requirements, including CMS, Medicare, Medicaid, TJC, and other compliance standards.
- Monitors and reports on hospital utilization data to improve efficiency and patient outcomes.
- Supports hospital and department mission and vision through best practices in case management.
Professional Development & Collaboration
- Attends department meetings and completes required education and competency training.
- Collaborates with nursing, medical staff, and ancillary departments to improve patient care processes.
- Serves as a resource for utilization and medical necessity issues across hospital departments.
Care:
- Provide case management to patients and families.
- Act as a point of contact for referral sources seeking patient admission to the Behavioral Health Unit and navigates accordingly.
- Participate in discharge planning, arrange follow-up care and develop mechanisms for exchanging appropriate information with sources outside the hospital in conjunction with the unit Social Worker.
Compliance:
- Assist with performance improvement activities within the department and participate in performance improvement activities.
- Support the Behavioral Health Unit with insurance verification/pre-certification/certification necessary for maximized patient reimbursement within the designated hospital’s Utilization Management program.
Community:
- Serve as a resource person to healthcare professionals concerning community resources.
- Represent the Behavioral Health Unit at various scheduled events.
Requirements
- Bachelor’s Degree, or higher, in Social Work or Nursing License - preferred
- Two or more years of previous experience in all aspects of social service or nursing with an emphasis on psychiatric work - preferred
- Excellent oral and written communication skills - required
- Verbal and written ability to give information and present ideas essential in administrative management - required
- Leadership ability, integrity, and initiative - required
- Ability to problem-solve effectively and positively handle stress - required
- BLS - required
- HWC training (will be provided) - required
- Basic computer knowledge - required
Salary : $32 - $48
