Utilization Management Clinician

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Job Summary As a Utilization Management Clinician, you will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.

Key Responsibilities

• Apply critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions.
• Assess appropriateness of treatment plans, apply evidence-based standards, and practice guidelines to treatment where appropriate.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provide triage and crisis support.
• Gather clinical information and apply clinical criteria/guidelines to render coverage determinations/recommendations.
• Coordinate with providers and other parties to facilitate optimal care/treatment.
• Identify members at risk for poor outcomes and facilitate referral opportunities.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Requirements

• Licensed independent Behavioral Health clinician (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in Louisiana or a Registered Nurse (RN) with unrestricted compact state license with psychiatric specialty experience.
• 3 years of clinical practice experience in a psychiatric hospital, residential, or behavioral health treatment setting.
• 1 year of Electronic Medical Record documentation experience.
• Must be able to work Monday through Friday, 8:00 AM to 5:00 PM CST with flexibility to work outside of the standard schedule.

Preferred Qualifications

• Reside in Louisiana.
• Managed care/utilization review experience.
• Experience in a behavioral health inpatient setting.
• Ability to multitask, prioritize, and adapt to a fast-paced environment.
• Proficiency with computer skills, including navigating multiple systems and keyboarding.
• LAC (Licensed Addiction Counselor) preferred.

Benefits

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.