Licensed Behavioral Health UM (RN, SW, Counseling, Psychology)
Core
Licensed Behavioral Health Utilization Management Professional coordinating medical services and benefit administration determinations for members.
Role type
Licensed Behavioral Health Utilization Management Professional
Builds
Medical necessity reviews and benefit administration determinations
Domain
Healthcare / Behavioral Health
Required skills
Clinical knowledge, independent critical thinking, policy interpretation, provider communication, MS Office proficiency, system navigation
Preferred skills
Behavioral Health UM experience, medical necessity review criteria (MCG, ASAM, InterQual), Managed Care, Medicaid, Health plan experience
Responsibilities
Interpret criteria, policies, and procedures to determine appropriate treatment; coordinate and communicate with providers and members to facilitate optimal care; make independent decisions regarding work methods in ambiguous situations.
Seniority
Mid-level, independent decision maker