UR Case Management Specialist

Rogers Behavioral Health

. Provide leadership in facilitating the treatment process from admission to discharge .

Posted 10/26/2026full-timeOconomowoc • Wisconsin • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization review, case management, and patient advocacy within behavioral health settings, ensuring compliance with regulatory standards and effective communication with interdisciplinary teams. Proficient in managing treatment processes, documentation, and aftercare planning to optimize patient outcomes.

Highest-signal resume keywords

Utilization Review ExperienceCase Management ExperienceKnowledge of Managed CareKnowledge of DSM and ICD-10Current CPR Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewCase ManagementMedical Necessity DocumentationData ProcessingElectronic Health Record ManagementTreatment PlanningRisk ManagementQuality AssurancePatient AdvocacyDocumentation Standards

Soft Skills

CommunicationCollaborationLeadershipProblem-SolvingTraining and Education

Tools & Technologies

Electronic Health Record SystemsWord Processing SoftwareSpreadsheet Software

Certifications & Qualifications

CPR CertificationS.A.F.E. Training Certification

Industry Keywords

Behavioral HealthManaged CareMedicaidMedicareJoint Commission StandardsRegulatory ComplianceInterdisciplinary Team MeetingsPatient Financial ServicesAftercare PlanningMental Health Treatment

About the role

Key responsibilities & impact

Provide leadership in facilitating the treatment process from admission to discharge
Monitor the treatment process to manage risk and ensure quality patient care and cost/quality outcomes
Act as liaison between Rogers Behavioral Health and third-party payers to advocate for medical necessity authorization
Provide utilization information to third-party payors and facilitate peer-to-peer reviews or expedited appeals
Coordinate with payers and non-Rogers providers to ensure aftercare is complete and appointments are scheduled
Attend and participate in interdisciplinary treatment team meetings
Review active medical records for medical necessity documentation and escalate documentation or quality care issues
Collaborate with leadership to provide feedback, education, and training on medical necessity documentation
Initiate physician advisory reviews as needed
Coordinate admissions, clinical teams, payer strategies, and patient financial services to obtain authorizations, agreements, or self-pay deposits
Identify, investigate, and resolve issues that place patients or Rogers Behavioral Health at risk
Lead aftercare and discharge planning with patients, families, clinicians, outpatient providers, insurance case managers, county services, legal stakeholders, and others
Assess patient and support-system needs for medication management, psychotherapy, medical care, housing, finances, community support, and county-based support
Complete and document aftercare plans, appointments, transfers, community resources, and provider communications in the electronic health record
Populate and maintain the referent/provider database in the electronic health record
Support utilization review process improvement initiatives and continuous improvement data collection
Assist new UR case management specialists and care advocates with standard work
Help create and implement standard work by identifying waste and collaborating on solutions
Communicate with clinical teams, admissions, and third-party utilization review and case management teams about case status
Assist patient financial services with reimbursement problem investigations
Communicate with patients and families regarding aftercare, insurance benefits, authorizations, costs, self-pay arrangements, and medical necessity denials
Promote department goals and the mission of Rogers Behavioral Health
Maintain department policies and procedures and incorporate Joint Commission and State of Wisconsin requirements
Educate staff regarding applicable regulations and requirements
Participate in regulatory education, in-services, seminars, and meetings

Requirements

What you’ll need

Bachelor’s Degree is required; Behavioral Science or Human Services is preferred
Two (2) years previous work experience required; office or hospital setting preferred
Knowledge of managed care, Medicaid and Medicare is preferred
Utilization review experience in a hospital, outpatient or managed care setting preferred
Case management experience in a hospital, outpatient or managed care setting preferred
Knowledge of the DSM, ICD-10, medical, mental health and chemical dependency diagnosis and treatment process is preferred
Computer skills are required, including word processing, spreadsheets and data processing
Knowledge of Joint Commission documentation and medical records standards and ability to maintain accurate records
Current American Heart Association CPR certification or American Red Cross Professional Rescue is required within thirty (30) days of date of hire; bi-annual re-certification is required
Formal training in the management of the aggressive patient (S.A.F.E.) is required within sixty (60) days of date of hire; annual re-certification is required
Demonstrated understanding of Joint Commission and other regulatory agency compliance regulations
Ability to involve self in the learning and application of standards relevant to the Admission Services department
Ability to participate in in-services, seminars, and other meetings to increase involvement and awareness of regulations

Benefits

Comp & perks

Health, dental, and vision insurance coverage for you and your family
401(k) retirement plan
Employee share program
Life/disability insurance
Flex spending accounts
Tuition reimbursement
Health and wellness program
Employee assistance program (EAP)