The Coord Utilization Case Manager is responsible for coordinating the Utilization Management activities for Behavioral Services in order to assure the ongoing, comprehensive monitoring and evaluation of patient care by conducting initial, concurrent, and retrospective review to assure appropriate reimbursement. Responsible for phone triage and completes assessments of potential patients to determine and arrange admission to the appropriate level of care.

• Collaborates with physicians, social workers, nurses, and other professionals to identify utilization problems, educate regarding appropriate resource use and facilitate case management to ensure patients are getting the right level of care, in the appropriate place, at the right time
• Assists the physician in preventing and/or appealing denials
• Collaborates with admitting and business office personnel to identify problems and facilitate reimbursement

Minimum Education

Associates degree in Nursing with directly related experience totaling 4 years

Preferred Education

BAor BS in Nursing

Experience in Mental Health and Addiction

Minimum Licensure/Certification/Registration

Licensed RN in Minnesota

Minimum Experience

3 5 years clinical experience with a minimum of 1 year experience working

with the Behavioral Services population.

Preferred Experience

Broad based clinical experience working with the Behavioral Services population

1 year utilization management

Additional Requirements:

Computer skills