Utilization/Case Manager

We’re a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”

Overview:

Provides referral, authorization, medical review, and case management services for members covered through Mercy Managed Behavioral Health. Assists with quality improvement program and the integration of QI processes into Medical Management as assigned.

Qualifications:

• Education: Registered Nurse or Masters in Social Work (MSW), Counseling (LCSW or LPC) or Psychology.
• Licensure: Current Registered Nurse, LCSW, LPC, or Psychologist.
• Experience: At least two years post license direct clinical experience in behavioral health setting and prior utilization management experience is strongly preferred.
• Other: Broad Knowledge of mental illness/substance use diagnosis and treatment protocols required.

Job Responsibilities: 

Assessment/Referral and Utilization Management:

1. Understands and utilizes professional skills in triaging phone calls to refer to appropriate provider/level of care/ or services.

2. Possesses skills to handle emergency and crisis calls.

3. Communicates well with members/providers/ and other callers via telephone handling calls with knowledge, efficiency, and compassion.

Utilization Management:

1. Possesses ability to perform pre-authorization, concurrent review, and discharge planning for members in any level of behavioral health care.

2. Understands and has knowledge of denial and appeal processes, peer review, timelines, and managed care processes for UM activities.

3. Understands and recognizes the role of EAP and recommends when appropriate for clients with that employer benefit. Prepares and refers cases to Medical Director for review appropriately.

Case Management:

1. Recognizes importance of Case Management (CM) for members with severe illnesses and high utilization.

2. Depending on assignments either refers members to CM, or manages patient care through CM processes.

3. Understands value and recognizes importance of treatment follow up and compliance, as well as external resources and services.

Record Keeping:

1. Documents in appropriate electronic health record information necessary for clinical authorization of services.

2. Utilizes QI form for documentation of QI or other Adverse issues.

Quality Improvement:

1. Is aware of the QI Program components for MMBH and actively participates in QI activities as assigned.

2. Documents complaints, quality issues, etc. for QI Manager on QI form. Identifies Adverse events or other critical incidents and alerts their leader.

We Offer Great Benefits:

Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!

We’re bringing to life a healing ministry through compassionate care.

At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all.

What Makes You a Good Match for Mercy?

Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and unafraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.

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