Clinical Utilization Case Manager

The Clinical Utilization Case Manager is the clinical link between our treatment team, the Center, and external payors and case management entities. This role would support the justification of continued residential treatment (RTC) care, ensure clinical documentation is accurate and complete, and maintain case files as required by regulatory agencies and managed care companies.

The ideal candidate is an organized, independent case manager who can translate quality care into clear, payor-ready documentation, and who is committed to supporting military-connected youth and their families.

Qualifications:

• Minimum 1 year of clinical experience in an inpatient mental health setting
• Ability to manage a caseload of at least 30 clients and meet critical submission deadlines
• Strong writing, proofreading, organizational, and time management skills; able to work independently and set priorities
• Ability to apply payor criteria to clinical information and write appropriate narrative reports
• Quantitative skills to prepare statistical data and reports
• Sensitivity to report content and liability issues
• Proficiency in Microsoft Office (Outlook, PowerPoint, Excel) and familiarity with EMRs and payor portals
• Preferred: Active LPN/RN licensure; BA/BS in a Human Services field; payor experience

This is an on-site position, with working hours from Monday through Friday, 8:30 a.m. to 5:00 p.m.

Responsibilities:

• Communicate with payors and case management companies, submitting documentation to justify the authorized level of care by required deadlines
• Conduct ongoing utilization review of paper and electronic records to support medical necessity for continued RTC care, and submit updated clinical status reports per payor guidelines
• Monitor service delivery for consistency with payor criteria, and report issues that could trigger an audit or jeopardize authorization to your supervisor
• Verify that treatment plans and staffing reports are accurate and include all payor-required elements
• Review treatment plan problem areas and goals to report client progress to payors
• Work with the treatment team monthly (in person or via Zoom, Teams, Outlook) to update reviews and goals and recommend solutions
• Collect and assess data for QI monitoring, suggest improvements, and report documentation issues to HIM and the responsible department
• Partner with departments and outside providers to ensure documentation is complete and to secure discharge and step-down support
• Complete the payor-required discharge summary within the required timeframe for case close-out

In addition to this meaningful work, Barry Robinson Center offers a competitive and comprehensive benefits package, outlined below

• Full benefits including medical, dental and vision insurance
• 403(b) retirement plan with company contribution
• Company paid life and long-term disability insurance
• Generous Paid Annual Leave (Vacation) 
• Paid Sick leave
• 8 Paid Holidays
• Tuition reimbursement, details below:
  • $3,000 per calendar year after 6 months of tenure
  • $5,000 per calendar year after 2 years of tenure 
• PLSF Eligible Non-Profit Organization (Public Service Loan Forgiveness Program)
• Employee Assistance Program (EAP)
• Annual performance reviews 
• Employee events and activities
• Opportunities for advancement
• And more!

The Barry Robinson Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Salary : $55,000 - $60,000