Texas Health Resources
Behavioral Health – Case Manager
Texas Health Resources, Arlington, Texas, United States, 76000
Behavioral Health — Case Manager
Bring your passion to THR so we are Better + Together. Work location: Texas Health Resources — Behavioral Health, Remote. Work hours: Full-time (40 hours) Monday — Friday 9:00AM — 5:00PM.
Education Master’s Degree Counseling or Social Work Required
Experience
3 Years Clinical psychiatric or chemical dependency experience Required
6 Months in case management or utilization review Required
Prior experience with EPIC EMR
Licenses and Certifications
LMSW – Licensed Master Social Worker Upon Hire Required Or
LCSW – Licensed Clinical Social Worker Upon Hire Required Or
LPC – Licensed Professional Counselor Upon Hire Required Or
LPC-A – Licensed Professional Counselor Associate Upon Hire Required Or
CPR – Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required And
ACPI – Advanced Crisis Prevention Intervention Training Upon Hire Preferred
What You Will Do Daily Payor and Chart Review Activities
Identify cases requiring certification or re-certification for third party payors.
Ensure reviews are initiated on all patients; conduct reviews on admission, continued stay and discharge as defined in behavioral health policies.
Review the treatment plan and advocate for additional services as indicated.
Consult with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete.
Review records of patients according to approved criteria. Verify appropriateness of the admission, continued stay and concurrence with government/third party payor regulations. Document all actions per required processes. Notify supervisor if patient is not meeting criteria.
Refer cases that do not meet criteria to supervisor, attending physician and other members of the treatment team as appropriate.
Maintain records for all reviews completed, including documenting all activity with the third-party payor and notes the number of certified days, dates of contact, authorization codes, and reference numbers for approval/disapproval.
Ensure the appropriateness of hospitalization or continued hospitalization in accordance with approved criteria.
Maintain records of criteria and correspondence with external agencies and insurance companies for reference.
Treatment Team Coordination
Attend multidisciplinary treatment team.
Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.
Provide timely feedback to the attending physician and treatment team members concerning continuing certification of days/service.
Collaborate with the treatment team and supervisor regarding continued stay and discharge planning issues.
Ensure coordination of benefits regarding continuity of care decisions.
Recommend and promote discharge planning activities that reflect patient medical necessity needs and third-party payor authorization.
Coordinate discharge planning as needed between the third-party payor and discharge planner(s).
Maintain current awareness of mental health activities in the community.
Maintain an awareness of community and market-related activities, including knowledge of the activities of other providers, needs of local payors, and the political climate related to mental health.
Remain current on all clinical techniques and age-related mental health competencies and provide direction to staff and facility personnel as needed.
Committees
Attend other hospital committees, task force meetings, and participate in Continuous Improvement (CI) teams as assigned.
Enhance the effectiveness and quality of the services provided by the organization.
Identify and address utilization management issues by the appropriate individuals/committees.
Compliance and Patient Advocacy
Maintain current knowledge of Medicare, federal and state regulatory requirements for documentation, record keeping, and patient rights.
Report any observed deficiencies in Medicare, federal and state regulatory requirements to supervisor and administrative leaders as appropriate.
Address potential utilization management issues with supervisor and administrative leaders to ensure appropriate use of the hospital’s resources.
Ensure that admission and continued hospitalization of third-party payor patients are appropriate and authorized.
Recognize and communicate ethical and legal concerns through established channels of communication.
Take action to protect patient rights and/or preferences and promote desired outcomes.
Demonstrate and document patient advocacy when appropriate.
Maintain confidentiality of facility employees and patient information.
Professional Standards
Provide and accept constructive feedback in a calm, respectful manner.
Complete required trainings: Code White, HIPAA, BLS/CPR, 1-hour each adolescent/adult/geriatric age-specific training, ethics training, Care Connect updates and training, and continuing education required for license completed annually.
Maintain education records.
Treat all staff courteously.
Maintain professional accountability.
Comply with personnel policies, e.g., Attendance Policy, Dress Code, Social Work Practice Act, etc.
Maintain required licensure and certifications.
Manage time and resources responsibly.
Utilize professional judgement to prioritize daily workflow consistently.
Adapt to changes in workload by demonstrating flexibility in UR needs.
Coordinate efficient communications with payor and customer stakeholders.
Comply with reimbursement related standards.
Identify ineffective and costly processes and provide suggestions for improvement.
Utilize resources cost effectively.
Denials and Appeals
Review denial work queues and denial documentation activities on a routine basis.
Review and appeal all denied behavioral health claims when appropriate to third-party payors.
Maintain current knowledge of appeal policies and procedures for third party payors.
Document ongoing efforts to resolve unpaid claims.
Coordinate with the insurance company physicians in appeals, expedited appeals, or denial processing as necessary.
Maintain ongoing contact and collaboration with the CBO, billing and coding departments.
Additional perks of being a Texas Health employee
Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program, and several other benefits.
Inclusive, supportive, people-first, excellence-driven culture makes us a great place to work every day.
Supportive team environment with outstanding opportunities for growth.
Do you still have questions or concerns? Feel free to email your questions to .
Texas Health Resources
#J-18808-Ljbffr
Education Master’s Degree Counseling or Social Work Required
Experience
3 Years Clinical psychiatric or chemical dependency experience Required
6 Months in case management or utilization review Required
Prior experience with EPIC EMR
Licenses and Certifications
LMSW – Licensed Master Social Worker Upon Hire Required Or
LCSW – Licensed Clinical Social Worker Upon Hire Required Or
LPC – Licensed Professional Counselor Upon Hire Required Or
LPC-A – Licensed Professional Counselor Associate Upon Hire Required Or
CPR – Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required And
ACPI – Advanced Crisis Prevention Intervention Training Upon Hire Preferred
What You Will Do Daily Payor and Chart Review Activities
Identify cases requiring certification or re-certification for third party payors.
Ensure reviews are initiated on all patients; conduct reviews on admission, continued stay and discharge as defined in behavioral health policies.
Review the treatment plan and advocate for additional services as indicated.
Consult with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete.
Review records of patients according to approved criteria. Verify appropriateness of the admission, continued stay and concurrence with government/third party payor regulations. Document all actions per required processes. Notify supervisor if patient is not meeting criteria.
Refer cases that do not meet criteria to supervisor, attending physician and other members of the treatment team as appropriate.
Maintain records for all reviews completed, including documenting all activity with the third-party payor and notes the number of certified days, dates of contact, authorization codes, and reference numbers for approval/disapproval.
Ensure the appropriateness of hospitalization or continued hospitalization in accordance with approved criteria.
Maintain records of criteria and correspondence with external agencies and insurance companies for reference.
Treatment Team Coordination
Attend multidisciplinary treatment team.
Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.
Provide timely feedback to the attending physician and treatment team members concerning continuing certification of days/service.
Collaborate with the treatment team and supervisor regarding continued stay and discharge planning issues.
Ensure coordination of benefits regarding continuity of care decisions.
Recommend and promote discharge planning activities that reflect patient medical necessity needs and third-party payor authorization.
Coordinate discharge planning as needed between the third-party payor and discharge planner(s).
Maintain current awareness of mental health activities in the community.
Maintain an awareness of community and market-related activities, including knowledge of the activities of other providers, needs of local payors, and the political climate related to mental health.
Remain current on all clinical techniques and age-related mental health competencies and provide direction to staff and facility personnel as needed.
Committees
Attend other hospital committees, task force meetings, and participate in Continuous Improvement (CI) teams as assigned.
Enhance the effectiveness and quality of the services provided by the organization.
Identify and address utilization management issues by the appropriate individuals/committees.
Compliance and Patient Advocacy
Maintain current knowledge of Medicare, federal and state regulatory requirements for documentation, record keeping, and patient rights.
Report any observed deficiencies in Medicare, federal and state regulatory requirements to supervisor and administrative leaders as appropriate.
Address potential utilization management issues with supervisor and administrative leaders to ensure appropriate use of the hospital’s resources.
Ensure that admission and continued hospitalization of third-party payor patients are appropriate and authorized.
Recognize and communicate ethical and legal concerns through established channels of communication.
Take action to protect patient rights and/or preferences and promote desired outcomes.
Demonstrate and document patient advocacy when appropriate.
Maintain confidentiality of facility employees and patient information.
Professional Standards
Provide and accept constructive feedback in a calm, respectful manner.
Complete required trainings: Code White, HIPAA, BLS/CPR, 1-hour each adolescent/adult/geriatric age-specific training, ethics training, Care Connect updates and training, and continuing education required for license completed annually.
Maintain education records.
Treat all staff courteously.
Maintain professional accountability.
Comply with personnel policies, e.g., Attendance Policy, Dress Code, Social Work Practice Act, etc.
Maintain required licensure and certifications.
Manage time and resources responsibly.
Utilize professional judgement to prioritize daily workflow consistently.
Adapt to changes in workload by demonstrating flexibility in UR needs.
Coordinate efficient communications with payor and customer stakeholders.
Comply with reimbursement related standards.
Identify ineffective and costly processes and provide suggestions for improvement.
Utilize resources cost effectively.
Denials and Appeals
Review denial work queues and denial documentation activities on a routine basis.
Review and appeal all denied behavioral health claims when appropriate to third-party payors.
Maintain current knowledge of appeal policies and procedures for third party payors.
Document ongoing efforts to resolve unpaid claims.
Coordinate with the insurance company physicians in appeals, expedited appeals, or denial processing as necessary.
Maintain ongoing contact and collaboration with the CBO, billing and coding departments.
Additional perks of being a Texas Health employee
Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program, and several other benefits.
Inclusive, supportive, people-first, excellence-driven culture makes us a great place to work every day.
Supportive team environment with outstanding opportunities for growth.
Do you still have questions or concerns? Feel free to email your questions to .
Texas Health Resources
#J-18808-Ljbffr