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.

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.

Qualifications

• 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.

Preferred Qualifications

• One (1) + years of experience with utilization review process.
• Experience with behavioral change, health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.

Benefits

Includes medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.