Utilization Management Clinical Consultant
Core
Coordinate, document, and communicate aspects of utilization/benefit management programs for behavioral health and medical conditions, assessing treatment plan appropriateness and facilitating optimal care.
Role type
Utilization Management Clinical Consultant
Builds
Healthcare services and benefits coordination for members
Domain
Behavioral Health / Utilization Management
Required skills
Clinical judgment, evidence-based care application, treatment plan assessment, triage and crisis support, discharge planning, provider coordination, risk identification, referral integration, quality improvement analysis
Preferred skills
Managed care/utilization review experience, inpatient behavioral health experience, addiction counseling expertise
Technologies
Electronic Medical Record (EMR) systems
Responsibilities
Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services; provide triage and crisis support; gather clinical information to render coverage determinations; consult with internal and external constituents on utilization management; identify members at risk for poor outcomes and facilitate referrals.
Seniority
Mid-level, hands-on IC