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Minnesota Licensed Pre Service Retrospective Behavioral Health Utilization Management Care Manager
Job Summary
A company is looking for a Minnesota Licensed Pre Service Retrospective Behavioral Health Utilization Management Care Manager.
Key Responsibilities:
- Implement effective utilization management strategies, including reviewing the appropriateness of pre and post-service healthcare services and ensuring appropriate resource utilization
- Monitor and analyze the delivery of healthcare services, educate providers and members, and identify and resolve quality issues
- Review and identify issues related to professional and facility provider claims data, determine code submission appropriateness, and take necessary actions for retrospective review and payment
Required Qualifications:
- Registered nurse with current MN license or licensed behavioral health clinician without restrictions or pending restrictions
- 3 years of related, progressive clinical experience
- Demonstrated ability to research, analyze, and problem solve complex issues
- Proficient in multiple PC-based software applications and systems
- Thorough understanding of state and federal regulations, accreditation standards, and member contracts
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COMPLETE JOB DESCRIPTION
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Company Overview
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