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Utilization Management/ Clinical Specialist 1 (Part Time- REMOTE)
BHM Healthcare Solutions
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Tampa, FL
Job details
Job Type
Part-time
Full Job Description
BHM is a national Independent Review Organization and consulting firm, established in 2002, that provides medical and behavioral health review services and performance improvement consulting. Our clients include healthcare delivery systems, pharmacies and pharmaceutical companies, insurers/payers, and government agencies/providers (including MCOs and ACOs).
Schedule:
Weekends and holidays are on an "on-call" rotating schedule
Salary: $26-29 dollars per hour. Compensation is commensurate with level of experience.
Monday - Friday 5PM - 9PM, rotating weekends. Position is remote after in person training is complete.
Fundamentals:
• Utilizes clinical skills to support the documentation and communication of medical and behavioral health service determinations
• Analyzes information to support the process of rendering appropriate medical necessity and/or benefit determinations
• Utilizes clinical experience, criteria/guidelines, and policies and procedures in support of ensuring timely and accurate medical necessity/benefit determinations
• Develops clinical review summaries and completes Peer Reviewer audits for medical and behavioral health determinations
• Acts as a liaison between Peer Reviewers and clients as well as a support for Peer Reviewers, including training and mentoring
• Employs strong customer service skills, both verbally and written, and client understanding to ensure a premiere experience for client interactions
Qualifications:
• Education • Graduate of Diploma Program required
• Bachelor's degree preferred
• Licensure • Active Clinical License (RN, LPN, LCSW, LMHT)
• Experience • Minimum 6 months experience of direct patient care preferred
• Experience processing clinical peer reviews for Utilization Management program preferred
For more information about BHM, visit www.bhmpc.com.