UM RN - Behavioral Health
Core
Utilization management and clinical coordination for behavioral health services, ensuring medical necessity and appropriate care levels across the healthcare continuum.
Role type
Utilization Management Registered Nurse (Behavioral Health)
Builds
Care plans, authorization decisions, and care coordination for health plan members.
Domain
Health Insurance / Behavioral Health
Required skills
Clinical assessment, care coordination, regulatory compliance, medical necessity determination, discharge planning, benefits analysis
Preferred skills
Case management certification, managed care experience, behavioral health clinical experience
Technologies
Microsoft Office Suite
Responsibilities
Review and authorize requests for elective, direct, ancillary, urgent, and emergency services; analyze and respond to retrospective review requests and appeals; establish and coordinate discharge planning; research and resolve issues related to member eligibility and coordination of benefits; develop education for the provider community; consult on utilization management functions.
Seniority
Mid-level, hands-on IC