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Utilization Management Behavioral Health Professional 2

Description
The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Utilization Management Behavioral Health Professional 2 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Master's Degree or equivalent
Applicable State licensure in field of study.
Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license
Health professional with a minimum of an associate's degree in nursing or at least three years practice experience, or a master's degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university
Minimum of 1 year of post-degree clinical experience in private practice or other patient care
Minimum of 1 year of managed care experience
Preferred Qualifications
Experience with utilization review process
Experience with behavioral change, health promotion, coaching and wellness
Experience working with the older adult population
Knowledge of community health and social service agencies and additional community resources
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Additional Information
Scheduled Weekly Hours
40

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