Utilization Manager Behavioral Health - Clinical licensure required
Company: Centene Corporation
Location: Dearborn
Posted on: January 14, 2021
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Job Description:
Job Description Position Purpose: Perform duties to authorize
and review utilization of mental health and substance abuse
services provided in inpatient, outpatient and intermediate care
settings, provide and/or review intakes and initial evaluations,
brief focused treatment interventions, monitor quality of care,
collect and analyze utilization and cost of care data, assist with
discharge planning, arrange transportation; provide member
assistance and participate in special utilization projects.
Authorize, direct and monitor care for mental health and substance
abuse problems according to clinical information given by providers
and internal criteria for medical necessity and appropriateness of
care. Ensure compliance with all performance measures in regards to
appeals, denials, higher level of care admission certification and
concurrent review timeliness, Outpatient Treatment Report review
timeliness, readmissions, and others as indicated. Interact with
physicians and social workers for discharge planning. Direct and
coordinate follow-up to ensure plans for continuity of care and
adherence to HEDIS standards. Compile and report daily review
activity and facility statistics. Participate in quality
improvement activities, supporting network development and
interfacing with treatment facilities and the professional
community. Verify subscriber eligibility and existing benefits for
mental health and substance treatment, prior to authorizing all
levels of treatment including concurrent outpatient. Track benefit
usage and advise appropriate parties of exhaustion of benefits.
Interact with Medical Director or designee to discuss clinical
authorization questions and concerns regarding specific cases.
Education/Experience: Master's degree in Behavioral Health or RN. 3
years experience in psychiatric and/or substance abuse health care
settings including utilization review. Working knowledge of
utilization review procedures, mental health and substance abuse
community resources and network providers. License/Certification:
Required to have license to practice independently, and/or have
obtained the state required licensure as outlined by the applicable
state. This includes but is not limited to licenses such as LPC,
LCSW, LMFT, LMHC, LIMHP, and RN. Centene is an equal opportunity
employer that is committed to diversity, and values the ways in
which we are different. All qualified applicants will receive
consideration for employment without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, disability, veteran status, or other characteristic
protected by applicable law.
Keywords: Centene Corporation, Dearborn , Utilization Manager Behavioral Health - Clinical licensure required, Healthcare , Dearborn, Michigan
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