Manager, Utilization Management – MSL/RN, Behavioral Health
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
• 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