Pay Range: $39/hr-$43/hr

About the Role

• We are seeking a dedicated and licensed professional to join our Utilization Management team, focusing on behavioral health.
• This role is fully remote and involves conducting utilization reviews to ensure members receive appropriate care.
• The position is open to candidates with a Kentucky license, including RNs, LCSWs, LPCCs, and LMFTs.
• Experience in behavioral health and utilization management is preferred.

Responsibilities

• Conduct utilization management reviews using the medical management system in accordance with department policies and procedures.
• Provide concurrent review and prior authorizations as needed, ensuring compliance with state and federal regulations.
• Identify appropriate benefits, eligibility, and expected length of stay for treatments and procedures.
• Collaborate with interdepartmental teams to enhance continuity of care, including Behavioral Health and Long Term Care.
• Maintain department productivity and quality measures.
• Participate in regular staff meetings and assist in mentoring new team members.
• Complete assigned work plan objectives and projects in a timely manner.
• Maintain professional relationships with providers and internal/external customers.
• Consult with medical directors as necessary and comply with workplace safety standards.

Education Qualification

• Must hold a valid Kentucky license as an RN, LCSW, LPCC, or LMFT.

Required Skills

• Strong communication, problem-solving, and interpersonal skills.
• Excellent organizational skills with the ability to manage multiple priorities.
• Ability to work independently and handle multiple projects simultaneously.
• Knowledge of applicable state and federal regulations. - In-depth knowledge of Interqual and other references for medical necessity determinations.
• Experience with NCQA is preferred.
• Proficiency in MS Office Products.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and comply with HIPAA regulations.
• Skilled at establishing and maintaining positive work relationships with coworkers, clients, members, providers, and customers.

Benefits

The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.