Behavioral Health Utilization Management Specialist

About the role

Location: Remote • Type: Contract To Hire

Responsibilities

• Perform prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage.
• Analyze clinical information, contracts, mandates, medical policy, evidence-based research, accreditation, and regulatory requirements to determine the appropriateness and authorization of clinical services, both medical and behavioral health.
• Determine medical necessity and appropriateness referencing regulatory mandates, benefit information, clinical guidelines, and medical references.
• Research and analyze pertinent diseases, treatments, and emerging technologies to support decisions and recommendations to medical directors.
• Collaborate with medical directors, provider and member services, sales, and marketing to ensure appropriate benefit application.
• Make appropriate referrals and contacts, assess alternative care settings, and provide educational presentations on cases and treatment modalities.

Requirements

• Master’s Degree in Psychology or Social Work
• Minimum 5 years of clinical experience
• 2 years of Care Management experience preferred
• Licenses: LCPC or LCSW-C in MD, DC, or VA
• Effective written and interpersonal communication skills
• Strong assessment skills and ability to rapidly connect with members telephonically
• Proficiency with web-based technology and Microsoft Office applications
• Knowledge of managed care, behavioral health delivery systems, and healthcare payer guidelines
• Experience in treatment of substance use and mental health disorders
• Ability to handle confidential data and PHI, prioritize workload, and multitask effectively

Benefits

• Medical, dental, vision coverage
• Spending accounts
• Life insurance
• Voluntary plans
• 401(k) plan participation

Pay

$50 per hour