Telecommute Healthcare Benefits Determination Utilization Manager

Job Summary

A behavioral health company needs applicants for an opening for a Telecommute Healthcare Benefits Determination Utilization Manager.

Individual must be able to fulfill the following responsibilities:

• Provide oversight and/or assist with benefit determinations
• Monitor IRO and physician advisor timeliness and provide reminder communication as needed
• Coordinate with the appeals team on the retrospective review process

Required Skills:

• Current, unrestricted license as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or as a Registered Nurse
• Minimum of 3-5 years of experience in a facility-based outpatient psychiatric or chemical dependency treatment center
• Strong clinical skills
• Strong computer and keyboarding skills (Microsoft Outlook and Word)
• Ability to comprehend medical policy and criteria to clearly articulate health information
• Experience with UM processes in accordance to URAC and NCQA