Utilization Management Behavioral Health Professional

About the role

The Utilization Management Behavioral Health Professional supports the coordination, documentation, and communication of medical services and/or benefit administration determinations. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

• Supports the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interprets criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Requirements

• Must meet one of the following:
• Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings).
• Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia.
• Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting.
• Minimum one, (1) year of managed care experience.
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills.

Qualifications

• Use your skills to make an impact.
• Must meet one of the following:
• Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings).
• Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia.
• Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting.
• Minimum one, (1) year of managed care experience.
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills.

Skills

• Utilization review process experience.
• Behavioral change, health promotion, coaching and wellness knowledge.
• Community health and social service agencies and additional community resources understanding.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities.