UR Case Management Specialist

Benefits

Job Description

Job Responsibilities & Requirements

Key Responsibilities:

• Act as primary liaison between Rogers Behavioral Health, third-party payors, and clinical teams to secure medical necessity authorizations, single-case agreements, and peer-to-peer reviews.
• Lead comprehensive discharge and aftercare planning from admission through post-discharge, scheduling follow-up appointments and linking patients to community resources.
• Review active medical records to ensure compliance with documentation requirements and Joint Commission standards.
• Collaborate with Admissions, Clinical Leadership, Payer Strategies, and Patient Financial Services to resolve care delivery and reimbursement issues.
• Assess patient needs for housing, medication management, psychotherapy, financial support, and county-based resources.
• Participate in process improvement initiatives, data collection, and onboarding/training of new UR department staff.

Requirements & Qualifications:

• Experience Level: Intermediate Level (Bachelor's degree + 2 years of work experience in healthcare/office setting).
• Education: Bachelor’s Degree required (Behavioral Science or Human Services preferred).
• Experience: Minimum of 2 years of previous work experience required (hospital or office setting preferred); experience in utilization review, case management, managed care, Medicaid, or Medicare strongly preferred.
• Knowledge & Skills: Familiarity with DSM-5/ICD-10, mental health and chemical dependency diagnoses, Joint Commission standards, and EMR database software; computer proficiency in spreadsheets and data processing.
• Certifications: Current AHA CPR or Red Cross Professional Rescuer certification required within 30 days of hire; formal training in aggression management (S.A.F.E.) required within 60 days of hire.

Rogers Behavioral Health is an Equal Opportunity / ADA / Drug-Free Workplace.