Job Description
- Job Description:
- Oversee all behavioral health utilization management activities ensuring consistency of services and achievement of utilization targets
- Assist in coordination and management of the pre-determination process of behavioral health services
- Ensure the consistent application of criteria for authorization decision
- Interact with providers and staff to manage benefits aligned with state-based regulations
- Review and revise workflows to maximize efficiencies
- Monitor productivity and utilization trends
- Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
- Regularly report all utilization management regulatory requirements
- Ensure compliance with and reporting of all regulatory requirements
- Maintain all behavioral health utilization management reporting and trend data
- Analyze under and over utilization information for impact on member quality of care and outcomes
- Develop, maintain and update all departmental policies and procedures
- Requirements:
- Associates degree in Nursing, behavioral health or related field required
- Bachelor's degree preferred
- Five (5) years of clinical experience required
- Five (5) years of experience in behavioral health, case management, utilization management, and/or quality improvement required
- Two (2) years utilization management experience preferred
- Managed Care experience preferred
- One (1) year Leadership experience required
- Beginning Excel, Word and PowerPoint experience
- Experience in data analysis and trending
- Knowledge of utilization management standards and practices
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the health care field
- Critical listening and thinking skills
- Training/teaching skills
- Strategic management skills
- Negotiation skills/experience
- Technical writing skills
- Time management skills
- Proper phone etiquette
- Customer service oriented
- Decision making/problem solving skills
- Leadership experience and skills
- Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Apply Now
Apply Now