Utilization Management Clinician Behavioral Health
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About The Position
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. As a Utilization Management Clinician - Behavioral Health you will utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate. You will coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members, provide triage and crisis support, gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning. You will also coordinate with providers and other parties to facilitate optimal care/treatment, identify members at risk for poor outcomes and facilitate referral opportunities to integrate with other products, services and/or programs, and identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. Additionally, you will consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functions. Must be able to talk on the telephone and type at the same time, this has some queue-based work involved.
