Utilization Management Behavioral Health Nurse

The Utilization Management Behavioral Health Nurse 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 Nurse 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.

Responsibilities

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Understands department, segment, and organisational 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.

Requirements

• Degree in Nursing
• Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
• 3+ years of post-degree clinical experience in direct patient care
• 3+ years of Behavioral Health experience
• Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.
• Ability to work independently.

Preferred Qualifications

• Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
• Managed Care, Medicaid or health plan experience

Workstyle

• Remote Work at Home

Location

• Indiana

Schedule

• Monday through Friday 8:00-5:00 PM Eastern Time

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance