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 consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functions.
