Adventist Healthcare seeks to hire an experienced Behavioral Health Social Worker Case Manager /Utilization Reviewer who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing.
As a SW/Case manager, you will:
•Collaborate with payors, care providers and review organizations to ensure proper utilization of patient care resources
•Review patient records according to payor contractual agreements or as needed
•Provide education, support and training for clinical staff regarding appropriate clinical documentation as well as guidelines for the Medicare 2 Midnight rule
•Discuss treatment update requests from the insurance with the multi-disciplinary treatment team and perform continued stay reviews, as required, by the payor.
•Provide notification to physician, if applicable, regarding timely and thorough progress note documentation
•Communicate with third party payers, third party payer initial denials
•Review admission service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
•Interact with Physicians and Care Management staff, Admitting and Accounts Receivable staff on a daily basis and assists with trouble shooting issues on an ongoing basis.
•Network with insurers to resolve those denial issues that can be managed successfully without appeal.
•Graduate of an accredited Master's program in Social Work, Psychology, Human Behavior, Nursing, and/ Public Health/ Administration
•Licensed in the state of Maryland
•Minimum of 2 years Utilization Review experience, and/ recent Utilization Review Experience, and an extensive and varied behavioral/mental health background
•Very strong computer and typing skills (35-40 wpm)
•2+ years acute Case Management experience
•Experience in a Managed Care environment
•Case Management Certification-to achieve within 2-5 yrs
•Able to use medical necessity screening tools, such as InterQual/MCG
•Able to handle a multi task environment
•Maintains current literature on preadmission screening criteria and policies and procedures of insurance carriers
•Active American Heart Association Basic Life
Support (BLS) certification required
At Adventist HealthCare our job is to care for you. We do this by offering:
•Work life balance through non rotating shifts
•Recognition and rewards for professional expertise
•Free Employee parking
•Competitive comprehensive benefit plans offered
(including health, disability, PTO and 403B
retirement plan with matching and 3 year vesting)
•100% Coverage for inpatient care - at Adventist
•100% Coverage for urgent care nationwide - after
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today! Apply now to be considered.
Full Time, remote
Adventist HealthCare requires all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination and , if offered, may elect to be vaccinated at a n designated Adventist HealthCare location.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.
Equal Employment Opportunity
Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.
Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs.
Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.