Utilization Management Clinician – Tuesday, Saturday
Posted 5ds ago
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Job Description
Utilization Management Clinician coordinating healthcare delivery for PacificSource members through collaboration with medical professionals. Assessing health plan benefits and promoting quality outcomes.
Responsibilities:
- Collaborate closely with physicians, nurses, social workers, and a wide range of medical and non-medical professionals
- Assess the member’s specific health plan benefits and additional resources available
- Provide utilization management (UM) services that promote quality, cost-effective outcomes
- Facilitate outstanding member care using fiscally responsible strategies
- Accurately document case notes and letters of explanation
- Perform concurrent reviews of members admitted to inpatient facilities and maintain contact with utilization review personnel
Requirements:
- Minimum of three (3) years of nursing or behavioral health experience
- Active, unrestricted Registered Nurse (RN) license OR Licensed Professional Counselor (LPC) OR Licensed Marriage and Family Therapist (LMFT) OR Licensed Clinical Social Worker (LCSW) OR Psychiatric Mental Health Nurse Practitioner (PMHNP)
- Case Manager Certification as accredited by CCMC preferred
- Thorough knowledge of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance, and state-mandated benefits
- Ability to use computerized systems for data recording and retrieval
Benefits:
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Options such as a flexible spending account
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