Utilization Manager
Location: Indianapolis Indiana
Description: Cenpatico is hiring Utilization Manager right now, this vacancy will be placed in Indiana. More complete informations about this vacancy opportunity please read the description below. 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 inta! kes 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.
Position Responsibilities:
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 d! aily 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.
Knowledge/Experience: Master's degree in Behavioral Health or Registered Nurse required. Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN with minimum of 3 years experience in psychiatric and/or substance abuse health care settings including utilization review. Knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.
License/Certificates: Unrestricted lice! nse as a LCSW, LMFT, PhD, PsyD or RN
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Cenpatico.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Thu, 12 Sep 2013 09:23:02 GMT
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