Utilization Management Behavioral Health Professional
Core
Utilize clinical knowledge and independent critical thinking to interpret criteria and policies, coordinating care and determining appropriate treatment courses for behavioral health members.
Role type
Utilization Management Behavioral Health Professional
Builds
Medical services coordination and benefit administration determinations
Domain
Healthcare / Behavioral Health / Managed Care
Required skills
Clinical knowledge, independent critical thinking, policy interpretation, care coordination, Microsoft Office (Excel, PowerPoint, Outlook, Word), troubleshooting technical difficulties
Preferred skills
Managed care organization experience, utilization review process experience, behavioral change coaching, substance use disorder knowledge, community resource knowledge
Responsibilities
Interpret criteria and policies to provide appropriate treatment decisions; Coordinate and communicate with providers and members to facilitate optimal care; Make decisions regarding work methods in ambiguous situations with minimal direction
Seniority
Mid-level, independent contributor