DescriptionThe Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Utilization Management Behavioral Health uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
- Degree in nursing or a Master's degree in a behavioral health related field such as social work, counseling, and/or psychology, from an accredited university.
- Possess a current, valid, and unrestricted license. Such licenses are: Licensed Masters Social Worker (LMSW or LMSW-ACP), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), PhD/EdD, or Registered Nurse (RN).
- Minimum of three (3) years of post-degree clinical experience in direct patient care required.
- Minimum of two (2) years of case management and/or rehabilitative counseling experience required. Certified or certified-eligible case manager required.
- Minimum one (1) year of clinical supervisory experience required.
- One (1) year of personnel management preferred.
- Proficiency with MS office products
Scheduled Weekly Hours40