Residential Case Manager

The Residential Behavioral Health Case Manager is responsible for executing all aspects of the continuing care plan, coordination with next level of care for step downs, facilitating insurance denial of care meeting with patients, and continuing care related administrative support for patients admitted to Suite 300 and Suite 500 residential programs. This role ensures continuity of care through proactive coordination with internal and external providers to facilitate admission to next level of care, facilitation of follow-up services, and support with administrative needs including insurance denial discussions and FMLA documentation. The Case Manager serves as a central point of contact for patients, TCs, and external providers to ensure a seamless transition throughout the continuum of care.

Primary Responsibilities:

Continuing Care Planning

• Coordinate all components of discharge plan for patients in Suite 300 and Suite 500 residential programs.
• Carry out the individualized discharge plan in collaboration with the treatment team, patient, and family (when appropriate).
• Coordinate step-down care, including scheduling intakes for recommended next LOC and admission dates, and other supportive services, such as sober living.
• Communicate with receiving providers to facilitate continuity of care and faxing discharge summary once completed by TC to next provider, if outside SCH.
• Maintain accurate and timely documentation of discharge planning activities (appointments, phone contact, intakes, etc.)

Care Coordination and Patient Support

• Serve as a primary liaison between patients, treatment team members, and external providers.
• Coordinate patient needs related to scheduling appointments with next level of care referrals in collaboration with business development for referrals outside of SCH.
• Be available for follow-up contact with patients and providers to ensure successful transitions post-discharge.
• Assist patients in navigating resources including community supports and sober living in collaboration with alumni and the Community Outreach and Alumni Coordinator at SunCloud Health.

Administrative and Documentation Support

• Populate accurate historical data from the EMR into FMLA, disability, and return-to-work/school paperwork in a timely and accurate manner. FMLA and disability paperwork will be completed and signed by TC and MD/medical provider.
• Assist patients with completion of their discharge surveys including self report measures of ED, SUD, trauma, mood, anxiety, quality of life and PSS measures.
• Maintain compliance with organizational policies, regulatory standards, and confidentiality requirements (HIPAA).

Financial Coordination and Patient Education

• Meet with patients to discuss insurance considerations related to their residential stay, including insurance denials, options for appeal and options for continued stay. coordinate contact with finance to discuss finance related concerns.
• Serve as a liaison between patients and billing/financial departments as needed.

Collaboration and Team Integration

• Participate in multidisciplinary treatment team meetings.
• Provide updates on progress and barriers to successful transition to next level of care.
• Collaborate with therapist staff, MD, utilization review, and admissions, to ensure coordinated patient care.

Qualifications:

Education

• Master’s degree required in Social Work, Psychology, Counseling, Healthcare Administration, or related field
• Professional license required

Experience

• Minimum of 1–2 years of experience in behavioral health, residential treatment, case management, or care coordination preferred
• Experience with discharge planning in a behavioral health setting strongly preferred
• Experience with insurance processes, FMLA, and disability paperwork preferred

Knowledge, Skills, and Abilities

• Strong understanding of behavioral health levels of care and treatment continuum
• Alignment with SCH mission of providing integrated, individualized care for individuals with complex, multi-occurring conditions.
• Excellent organizational and time management skills
• Ability to manage multiple cases and priorities effectively
• Strong interpersonal and communication skills
• Ability to work collaboratively within a multidisciplinary team
• Ability to maintain professional boundaries and confidentiality
• Proficiency in electronic medical records (EMR) systems and documentation