Utah Healthcare Jobs

Mobile utah department of workforce services Logo

Job Information

REGENCE BLUECROSS BLUESHIELD OF UTAH Behavioral Health Utilization Management in SALT LAKE CITY, Utah

Job Title: Behavioral Health Utilization Management ClinicianBehavioral Health Utilization Management Clinician Telecommute within WA, OR, UT, or IDProvides utilization management (such as prospective concurrent and retrospective review) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services. May have responsibility for oversight of Applied Behavioral analysis for Autism Spectrum Disorder.Responsibilities* Prospective: Utilization management conducted prior to a patient's admission, stay, or other service or course of treatment (including outpatient procedures and services). Sometimes called "precertification review" or "prior authorization," prospective review can include prospective prescription drug utilization review.* Concurrent: Utilization management conducted during a patient's hospital stay or course of treatment (including outpatient procedures and services). Sometimes called "continued stay review".* Retrospective: Review conducted after services (including outpatient procedures and services) have been provided to the patient.* Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care. Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.* Consults with physician advisors to ensure clinically appropriate determinations.* May facilitate transitions of care through collaboration with the member, the facilities interdisciplinary team and Regence's Case Management to achieve optimal recovery for the member.* Serves as a resource to internal and external customers.* Collaborates with other departments to resolve claims, quality of care, member or provider issues.* Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.* Responds in writing, by phone, or in person to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.* Provides consistent and accurate documentation.* Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.Minimum Requirements* Experience with higher levels of behavioral health care (inpatient hospital, residential, partial hospital program) and Applied Behavior Analysis Therapy strongly preferred.* Knowledge of health insurance industry trends, technology and contractual arrangements.* General computer skills (including use of Microsoft Office, Outlook, internet search).* Familiarity with health care documentation systems.* Strong verbal, written and interpersonal communication and customer service skills.* Ability to interpret policies and procedures and communicate complex topics effectively.* Strong organizational and time management skills with the ability to manage workload independently.* Ability to think critically and make decisions within individual role and responsibility.Normally to be proficient in the competencies listed above:* Behavioral Health Utilization Management Clinician would have a Master's Degree in Behavioral Health Discipline and 3 years of utilization management or behavioral health care management experience or equivalent combination of education and experience. Experience with Applied Behavior Analysis preferred.Required Licenses, Certifications, Registration, Etc.* Must have 3 years direct behavioral Health clinical experience as an independently licensed Master's level Behavioral Health Clinician in one of the areas of Psychology, Counselling, Social Work, Marriage and Family Therapy; or BCBA (Board Certified Behavioral Analyst). Clinical License must be unrestricted and current in state of residence. Must be licensed in WA, OR, ID or UT and willing to be licensed in multiple states.(No associate level- int

DirectEmployers