Job Summary:


Responsible for carrying out discharge planning activities and medical necessity reviews on all behavioral health, alcohol & drug, and dual diagnosis members admitted for inpatient treatment, partial hospital programs and external outpatient services utilizing established criteria and guidelines. The activities will include onsite and some telephonic review of all services, referrals and coordination of transfers. In addition they will perform eligibility and benefit reviews as necessary, discharge planning, identification of patients for case management, quality improvement reviews, education of the member/family, provider and hospital staff, and communication with inpatient care coordinators, case managers, home care reviewers, members, providers, Member Services, Claims, Contracts and Benefits - Appeals, Risk Management.

Essential Responsibilities:


+ Responsible for the day-to-day Behavioral Health case management and review activit...