Health Services - Spec, Utilization Management

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Health Services - Spec, Utilization Management

Location(s): MD, DC, or VA

Job Summary:

Utilizing key principles of utilization management, the Behavioral Health Utilization Management Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Behavioral Health Utilization Management Specialist will analyze clinical information, contracts, mandates, medical policy, evidence-based published research, national accreditation and regulatory requirements to contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.

Key Responsibilities:

• Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and accepted medical/pharmaceutical references.
• Conduct research and analysis of pertinent diseases, treatments and emerging technologies to support decisions and recommendations made to the medical directors.
• Make appropriate referrals and contacts as appropriate. Offer assistance to members and providers for alternative settings for care.

Required Qualifications:

• Master’s Degree in Psychology or Social Work.
• 5 years of clinical experience required; 2 years of care management preferred.
• Licensed in MD, DC or VA as LCPC or LCSW-C.
• Effective written and interpersonal communication skills.
• Proficient in Microsoft Office applications such as Word, Excel, and PowerPoint.

Benefits Overview:

• Health & Wellness: Comprehensive pre-tax health, dental, and vision insurance options.
• Life Insurance: Group term life insurance and voluntary life insurance coverage.
• Retirement Savings: 401(k) retirement savings plan to help you plan for your future.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.