Behavioral Health – Utilization Management Clinical Consultant

Behavioral Health – Utilization Management Clinical Consultant

Requirements

• Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license or a compact license that covers Kentucky with psychiatric specialty, or behavioral health experience or certification
• 3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, alternative care setting, or outpatient care exp.
• Willing and able to work Sunday – Thursday, 8am – 5pm EST with some flexibility to work outside of the standard schedule based on business needs

Responsibilities

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis support.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Preferred Qualifications

• Managed care/utilization review experience
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Experience using MS office applications including Teams, Outlook, Excel, and Word