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    Behavioral Health Utilization Management Specialist - Indianapolis, United States - Professional Management Enterprises

    Professional Management Enterprises
    Professional Management Enterprises Indianapolis, United States

    1 week ago

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    Description

    Job Description

    Job DescriptionDescription:

    Ideal candidate will have Behavioral Health experience in a health care setting and or Utilization Review/ Case Management. This is a full-time position Sunday-Thursday 8am-5pm. The pay for the role is $76,000/yr. This position is primarily provider facing.

    · Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.

    · Refers cases to Peer Reviewers as appropriate.

    · Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes

    · Optimize member health benefits and to promote effective use of health benefits and community resources.

    Requirements:

    · Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment.

    o or any combination of education and experience which would provide an equivalent background.

    · Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.

    · Licensure is a requirement for this position. However, for states that do not require licensure a Board-Certified Behavioral Analyst (BCBA) is also acceptable if all the following criteria are met:

    o performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.

    Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.

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