UR/Case Manager

The Utilization Review/Case Manager is responsible for coordinating patient care services and managing utilization review functions to ensure appropriate level of care, timely insurance authorization, and effective discharge planning. This role serves as the primary liaison between the hospital, payor sources, patients, families, and referral partners to support optimal clinical and financial outcomes.

In accordance with The Joint Commission standards, federal and state regulations, and Freedom’s mission, policies, and Performance Improvement (PI) program, the Case Manager facilitates the continuum of care from admission through discharge.

Key Responsibilities:

• Coordinates with Admissions and Clinical staff to ensure patient treatment needs are identified and met throughout the stay
• Conducts utilization review activities, including securing initial and continued stay authorizations from insurance providers
• Serves as the primary point of contact with payors, communicating medical necessity, level of care, and continued stay criteria
• Develops, implements, and manages discharge plans to ensure safe and appropriate transitions of care
• Communicates effectively with patients, families, and referral sources to support positive treatment outcomes
• Gathers and presents clinical information to the multidisciplinary treatment team; actively participates in treatment team meetings
• Maintains consistent communication with physicians, nursing, social services, and other disciplines to ensure coordinated care delivery
• Documents all utilization review and discharge planning activities accurately and timely in the medical record, supporting intensity of service and medical necessity
• Collaborates with external agencies and providers to coordinate aftercare services and continuity of care
• Ensures patient rights, ethical standards, and confidentiality are upheld at all times
• Participates in Performance Improvement (PI) and Quality Management (QM) activities, including data collection and process improvement initiatives

Qualifications & Skills:

• Strong understanding of behavioral health levels of care, medical necessity criteria, and insurance authorization processes
• Ability to effectively communicate with multidisciplinary teams, payors, patients, and families in a professional manner
• Excellent organizational, documentation, and time management skills
• Knowledge of regulatory and accreditation standards related to case management and utilization review
• Ability to manage multiple priorities while maintaining accuracy and compliance