Behavioral Health Utilization Review Specialist (LCSW/LMFT/LMHC or RN) - Health Plan
WFH - Austin, TX
*** This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 6 months, or longer! ***
Utilization Review Specialist Job Summary:
The Utilization Review Specialist is primarily a provider facing role, although it does involve some member activities such as collecting information and using clinical expertise to ensure members are directed to the appropriate level of care.
Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
Uses appropriate screening criteria, knowledge and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.
Refers cases to Peer Reviewers as appropriate.
Performs psychiatric and substance abuse or substance abuse disorder assessment, coordination, implementation, case planning, monitoring, and evaluating to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources.
The Utilization Review Specialist will review approximately 20-25 cases per day.
Utilization Review Specialist Background:
Requires a master's degree prepared individual with valid and unrestricted state licensure in Behavioral Health, such as a Licensed Clinical Social Work (L.C.S.W.), a Licensed Marriage and Family Therapist (L.M.F.T.), or a Licensed Mental Health Counselor (L.M.H.C.), etc with established behavioral health experience.
Will consider Registered Nurses (R.N.) that have extensive psychiatric/ behavioral health experience.
Requires 3-5 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment.
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases is preferred.
Computer skills to include Microsoft Office, database use, and basic data entry; position requires use of MACE, FACETS, and ability to reference/record clinical notes on 3 screens at once.