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
Associates degree in Nursing with directly related experience totaling 4 years
BAor BS in Nursing
Experience in Mental Health and Addiction
Licensed RN in Minnesota
3 5 years clinical experience with a minimum of 1 year experience working
with the Behavioral Services population.
Broad based clinical experience working with the Behavioral Services population
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.