Submission for the position: Utilization Manager - (Job Number: 1324168)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1324168&lang=en
Utilization Manager
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
"This position is a remote opportunity"
Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects.
• Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
• Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
• Interact with physicians and social workers for discharge planning.
• Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
• Compile and report daily review activity and facility statistics.
• Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
• Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
• Track benefit usage and advise appropriate parties of exhaustion of benefits.
• Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.
Education/Experience: Master’s degree in Behavioral Health or RN. 3 years experience in psychiatric and/or substance abuse health care settings including utilization review. Working knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.
License/Certification: Required to have license to practice independently, and/or have obtained the state required licensure as outlined by the applicable state. This includes but is not limited to licenses such as LPC, LCSW, LMFT, LMHC, LIMHP, and RN.
Our Comprehensive Benefits Package:
• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
• Competitive pay
• Paid Time Off including paid holidays
• Health insurance coverage for you and dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Clinical & Nursing
USA-Florida-Tampa
USA-North Carolina-Raleigh, USA-Georgia-Augusta
Schedule: Full-time Location(s): USA-Florida-Tampa