Utilization Management Specialist

Utilization Management SpecialistUnder general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information; assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.Hours of operation for the Department: M- F 8:00am – 7:00pm. This position is 98% telephonic. At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience. There will be rounds with a Doctor for 15 mins every day. Travel maybe required to a local hospital with a mileage rate of $0.54/mile. Training will be 3 – 4 weeks long that will include Code of Conduct, Systems App and Shadowing. Credentialing Paperwork will be completed during training. Required License: LCSW, LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor Degree is required. The Master Degree is required for all other licensing.