Mental Health/Substance Use Utilization Management Clinician

4 weeks ago


Wilmington, Delaware, United States Vaya Health Full time
Job Summary

Vaya Health seeks a highly skilled Mental Health/Substance Use Utilization Management Clinician to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive the most appropriate and effective care for their mental health and substance use needs.

Key Responsibilities
  • Conduct thorough reviews of Service Authorization Requests (SARs) and Person-Centered Plans (PCPs) to ensure that they meet established standards for medical necessity.
  • Provide feedback and request additional information from providers as needed, including consultation and education on evidence-based practices.
  • Authorize requested services that meet authorization requirements and medical necessity, while also ensuring that members receive the most effective and efficient care possible.
  • Collaborate with providers and other agencies to facilitate the development of the provider network and improve services to high-risk members.
  • Stay up-to-date on the latest clinical knowledge and best practices in mental health and substance use treatment.
Requirements
  • Master's degree in a Human Services field.
  • Two years of post-degree progressive experience and practice in a clinical area relevant to the position.
  • Experience in a Utilization Management environment in Behavioral Healthcare is required.
  • Current, active, unrestricted professional license or certification from North Carolina in a Human Services field.
What We Offer

Vaya Health is an equal opportunity employer and offers a competitive salary and benefits package to our employees. We are committed to providing a work environment that is inclusive, respectful, and supportive of our employees' needs.



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