Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
This position is for a utilization management clinician. The individual will perform utilization management as well as discharge planning activities for members undergoing mental health and chemical dependency treatment.
3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Managed care/utilization review experience preferred
Crisis intervention skills preferred
The minimum level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
Mental Health/Licensed Clinical Social Worker is required
Mental Health/Licensed Professional Counselor is required
Mental Health/Licensed Mental Health Counselor is required
Registered Nurse (RN) is required
Functional - Clinical / Medical/Precertification/1+ Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1+ Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1+ Years
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Communicating for Impact/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION