Utilization Management Clinical Consultant
Core
Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program for child and adolescent members.
Role type
Utilization Management Clinical Consultant
Builds
Coverage determination/recommendation/discharge planning along the continuum of care
Domain
Behavioral health / Utilization management
Required skills
Clinical judgment, Medical necessity criteria application, Care coordination, Crisis support/triage, Referral facilitation, Quality effectiveness promotion
Preferred skills
Mental health system experience, Outpatient services knowledge, Cross-department collaboration
Technologies
None stated
Responsibilities
Coordinate and communicate with providers to facilitate optimal care/treatment, Evaluate and facilitate appropriate healthcare services/benefits for members, Identify members who may benefit from care management programs and facilitate referral, Gather clinical information and apply guidelines to render coverage determination/recommendation/discharge planning
Seniority
Mid-level, hands-on IC