Behavioral Health Utilization Management Specialist

5 hours ago


Indianapolis, Indiana, United States Professional Management Enterprises Full time

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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