DESCRIPTION OF POSITION:
- The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.
SUPERVISION: Reports directly to Director of Psychiatric Services
RESPONSIBILITIES AND DUTIES:
- Prepares information for notification letters for providers and employees.
- Performs utilization review in accordance with all state mandated regulations.
- Maintains compliance with regulation changes affecting utilization management.
- Performs continuing review on medical records and identification and need of on-going hospitalization.
- Reviews patients' records and evaluates patient progress.
- Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review.
- Reviews and validates physician's orders, reports progress and unusual occurrences on patients.
- Receives & processes requests for appeal of denials.
- Attends required meetings regarding approvals, denials, pre-certs, authorizations and retro reviews.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
EDUCATION AND WORK EXPERIENCE
- BA required, Social Work preferred OR Nursing Certification with RN preferred
- Minimal 3-5 Years Experience working with mentally ill &/or addictions required
- Louisiana Nursing License or multi-state compact nursing license preferred, Crisis Response Training, CPR
- Ability to communicate with patient, family, peers and medical personnel.
- Requires emotional stability and resilience.
- Must be adaptable to change, be decisive, and demonstrate foresight.
- Exhibits organizational and leadership ability.
- Shows ability to gain and maintain support and respect.
Physical Demands/Work Environment
- Work requires a variety of physical activities including sitting, standing and walking.
- Bending, stooping, and lifting are minimal.
- The work environment may be physically confining.
- Visual acuity required for a variety of activities.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.
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