Behavioral Health Utilization Management Specialist
5 hours ago
Job Summary
Professional Management Enterprises seeks a skilled Behavioral Health Utilization Management Specialist to join our team. As a key member of our healthcare team, you will play a crucial role in ensuring that our members receive high-quality, cost-effective behavioral healthcare.
Key Responsibilities
- Assess member needs and ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.
- Refer cases to Peer Reviewers as appropriate.
- Perform psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes.
Requirements
- Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment or any combination of education and experience which would provide an equivalent background.
- Current active unrestricted license, such as RN LCSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
Preferred Qualifications
- Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
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