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Clinical/Behavioral Health Specialist, Utilization Management
7 days agoWhat's your preference?
Job Description
- Req#: 199
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Remote work opportunity, allowing for flexibility in your work environment
- Engaging role that involves critical thinking and decision-making in a supportive healthcare setting
- Opportunity to collaborate with a dedicated Care Management Team and local healthcare providers
- Chance to impact patient care by ensuring timely access to necessary medical services
- Commitment to diversity, equity, and inclusion in the workplace, fostering a supportive culture
What to Expect (Job Responsibilities):
- Perform medical necessity reviews for authorization of behavioral health and some medical services
- Coordinate medical services to ensure members receive appropriate care in a timely manner
- Use evidence-based clinical criteria to assess clinical documentation for medical necessity
- Establish and maintain relationships with healthcare providers and community resources
- Document interactions and processes accurately and in accordance with established policies
What is Required (Qualifications):
- Completion of an accredited registered nursing (RN) or licensed practical nursing (LPN) degree program
- Minimum of one (1) year of experience in Utilization Management/Utilization Review
- Minimum of two (2) years of behavioral health clinical experience
- Current, unrestricted Maine RN or LPN license, or compact state equivalent
- Proficiency in Microsoft Office and clinical documentation
How to Stand Out (Preferred Qualifications):
- Experience with MCG Guidelines
- Change resiliency and ability to adapt to varying operational priorities
- Strong interpersonal and communication skills
#HealthcareServices #RemoteWork #ClinicalSpecialist #PatientCare #UtilizationManagement
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