Utilization Review/Case Manager

Job Description

Utilization Review / Case Manager

Freedom Behavioral Hospital of Magnolia

Magnolia, Mississippi

Freedom Behavioral Hospital of Magnolia is currently accepting applications for a full-time Utilization Review (UR)/Case Manager to join our behavioral health team. This position plays a vital role in ensuring patients receive appropriate, medically necessary care while coordinating discharge planning and maximizing reimbursement through effective utilization management.

The ideal candidate is organized, detail-oriented, and passionate about helping patients successfully transition through every stage of their behavioral health treatment.

Position Summary

The Utilization Review/Case Manager is responsible for coordinating all aspects of utilization management, insurance authorization, concurrent reviews, discharge planning, and continuity of care for patients admitted to the psychiatric hospital. This position serves as a liaison between physicians, insurance companies, patients, families, and community providers to ensure appropriate levels of care, timely authorizations, and safe discharge planning.

Essential Job Responsibilities

Utilization Review

Complete admission reviews and obtain insurance authorizations.

Perform concurrent reviews with commercial insurance, Medicare Advantage, Medicaid Managed Care, and other third-party payers.

Submit clinical documentation supporting medical necessity.

Coordinate peer-to-peer reviews when required.

Monitor authorization status and approved lengths of stay.

Manage denial prevention and appeal processes.

Maintain accurate utilization review documentation.

Ensure compliance with payer guidelines and regulatory requirements.

Track authorization dates and notify providers of pending reviews.

Case Management

Complete psychosocial and discharge planning assessments.

Coordinate interdisciplinary treatment planning.

Develop individualized discharge plans beginning at admission.

Arrange follow-up appointments with outpatient providers.

Coordinate referrals to:

Intensive Outpatient Programs (IOP)

Partial Hospitalization Programs (PHP)

Community Mental Health Centers

Primary Care Providers

Nursing Facilities

Assisted Living Facilities

Home Health Agencies

Substance Use Treatment Programs

Arrange transportation for discharge when needed.

Collaborate with families and caregivers throughout hospitalization.

Coordinate transfers to higher or lower levels of care as appropriate.

Care Coordination

Participate in daily treatment team meetings.

Collaborate with psychiatrists, nursing staff, therapists, social workers, and administration.

Communicate with insurance case managers and payer representatives.

Ensure continuity of care following discharge.

Facilitate patient and family meetings as needed.

Documentation

Maintain complete, accurate, and timely documentation within the electronic medical record.

Document utilization reviews, discharge planning activities, and communications with payers.

Maintain records supporting medical necessity and reimbursement.

Ensure documentation meets CMS, Joint Commission, and Mississippi Department of Health requirements.

Regulatory Compliance

Maintain compliance with:

CMS Conditions of Participation

Joint Commission standards

HIPAA

Mississippi Department of Health regulations

Hospital policies and procedures

Participate in quality improvement and survey readiness activities.

Qualifications

Required

Minimum of two years of experience in behavioral health, case management, utilization review, or discharge planning.

Strong knowledge of behavioral health levels of care and medical necessity criteria.

Excellent communication and organizational skills.

Computer proficiency and experience with electronic medical records.

Preferred

Behavioral Health or Psychiatric Hospital experience.

Experience with Medicare, Medicaid, and commercial insurance authorizations.

Knowledge of InterQual® or MCG® medical necessity criteria.

Experience with utilization review and denial management.

Discharge planning and community resource coordination.

Benefits

Freedom Behavioral Hospital offers a competitive compensation and benefits package, including:

Competitive salary

Medical, dental, and vision insurance

Paid Time Off (PTO)

Paid holidays

Retirement plan

Continuing education opportunities

Supportive team environment

Professional growth and advancement opportunities

Freedom Behavioral 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 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.