Manager, Utilization Management – MSL/RN, Behavioral Health
CareSource
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $83,000 - $132,800 per year
About the role
- Oversee all behavioral health utilization management activities ensuring consistency of services and achievement of utilization targets
- Assist in coordination and management of the pre-determination process of behavioral health services
- Ensure the consistent application of criteria for authorization decision
- Interact with providers and staff to manage benefits aligned with state-based regulations
- Review and revise workflows to maximize efficiencies
- Monitor productivity and utilization trends
- Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
- Regularly report all utilization management regulatory requirements
- Ensure compliance with and reporting of all regulatory requirements
- Maintain all behavioral health utilization management reporting and trend data
- Analyze under and over utilization information for impact on member quality of care and outcomes
- Develop, maintain and update all departmental policies and procedures
Requirements
- Associates degree in Nursing, behavioral health or related field required
- Bachelor's degree preferred
- Five (5) years of clinical experience required
- Five (5) years of experience in behavioral health, case management, utilization management, and/or quality improvement required
- Two (2) years utilization management experience preferred
- Managed Care experience preferred
- One (1) year Leadership experience required
- Beginning Excel, Word and PowerPoint experience
- Experience in data analysis and trending
- Knowledge of utilization management standards and practices
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the health care field
- Critical listening and thinking skills
- Training/teaching skills
- Strategic management skills
- Negotiation skills/experience
- Technical writing skills
- Time management skills
- Proper phone etiquette
- Customer service oriented
- Decision making/problem solving skills
- Leadership experience and skills
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisutilization managementcase managementquality improvementbehavioral healthclinical experiencepolicy developmentworkflow revisionreportingtrend analysis
Soft Skills
leadershipattention to detailcritical thinkingstrategic managementnegotiationtime managementcustomer servicedecision makingproblem solvingtraining
Certifications
Associates degree in NursingBachelor's degree in related field