Utilization Management Clinical Consultant
Core
Coordinate, document, and communicate aspects of utilization/benefit management programs for child and adolescent members, applying clinical judgment to coverage determinations and discharge planning.
Role type
Utilization Management Clinical Consultant
Builds
Coverage determinations, discharge plans, and care coordination for pediatric members
Domain
Healthcare / Behavioral Health
Deliverable
client delivery
Required skills
Clinical judgment, medical necessity criteria application, care coordination, documentation, triage/crisis support, referral facilitation
Preferred skills
Hospital/outpatient/residential behavioral health experience, electronic documentation, Microsoft Office Suite, cross-departmental collaboration
Technologies
Internal/external computer systems, Microsoft Office Suite (Word, Excel)
Responsibilities
Coordinate and communicate with providers to facilitate optimal care; evaluate and facilitate appropriate healthcare services including urgent interventions; identify members for care management programs; promote quality effectiveness of healthcare services
Seniority
Mid-level, hands-on IC