Job Summary

A managed care organization focused on healthcare solutions for low-income and chronically ill people is searching for a person to fill their position for a Behavioral Health Utilization Management Reviewer.

Candidates will be responsible for the following:

• Completing medical necessity reviews
• Reviewing provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review
• Using his/her professional judgment to evaluate requests to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management

Position Requirements Include:

• Registered Nurse
• Graduate from an accredited institution with an Associate Degree or Bachelor’s Degree
• Master's degree preferred; or LSW, LPC, LMFT licensure with a Master’s Degree
• Minimum 3 years’ experience in a related clinical setting
• Managed Care and Utilization Management experience required
• Behavioral Health Management experience required