Job Summary
A nonprofit healthcare company dedicated to delivering consumer-centric solutions has an open position for a Remote Behavioral Health Utilization Management Clinician.
Individual must be able to fulfill the following responsibilities:
- Apply clinical expertise & judgment to ensure compliance with medical policy, medical necessity guidelines & accepted standards of care
- Consult with physician advisors to ensure clinically appropriate determinations
- Facilitate transitions of care through collaboration with the member, the facilities interdisciplinary team & Case Management
Applicants must meet the following qualifications:
- Knowledge of health insurance industry trends, technology and contractual arrangements
- General computer skills (including use of Microsoft Office, Outlook, internet search)
- Familiarity with health care documentation systems
- Ability to interpret policies and procedures and communicate complex topics effectively
- Strong organizational and time management skills with the ability to manage workload independently
- Strong verbal, written and interpersonal communication and customer service skills
