Behavioral Health Utilization Management Specialist

System One; Baltimore (MD); Remote; USD 58,000 - 79,000; Part time

Job summary

System One is seeking a Behavioral Health Utilization Management Specialist for a remote contract-to-hire position. You will perform prospective, concurrent, and retrospective reviews for authorization and benefit coverage, and analyze clinical information to determine medical necessity in behavioral health services.

You will collaborate with medical directors and member services, research treatments, and present on cases and modalities.

Qualifications

• Master’s degree in psychology or social work is required.
• Minimum 5 years of clinical experience.
• 2 years of care management experience preferred.
• Licenses LCPC or LCSW-C in MD, DC, or VA.
• Effective written and interpersonal communication skills.
• Strong assessment skills and ability to rapidly connect with members telephonically.
• Proficiency with web-based technology and Microsoft Office applications.
• Knowledge of managed care, behavioral health delivery systems, and payer guidelines.
• Experience in treatment of substance use and mental health disorders.
• Ability to handle confidential data and PHI, prioritize workload, and multitask effectively.

Responsibilities

• Perform prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage.
• Analyze clinical information, contracts, mandates, medical policy, evidence-based research, accreditation, and regulatory requirements to determine the appropriateness and authorization of clinical services, both medical and behavioral health.
• Determine medical necessity and appropriateness referencing regulatory mandates, benefit information, clinical guidelines, and medical references.
• Research and analyze pertinent diseases, treatments, and emerging technologies to support decisions and recommendations to medical directors.
• Collaborate with medical directors, provider and member services, sales, and marketing to ensure appropriate benefit application.
• Make appropriate referrals and contacts, assess alternative care settings, and provide educational presentations on cases and treatment modalities.

Skills

Assessment skills

Written & interpersonal communication

Telephonic member engagement

Confidential data handling

Education

Master’s Degree in Psychology or Social Work

Tools

Microsoft Office

Job description

Job Title: Behavioral Health Utilization Management Specialist
Location: Remote
Type: Contract To Hire
Compensation: $50 per hour

Responsibilities

• Perform prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage.
• Analyze clinical information, contracts, mandates, medical policy, evidence-based research, accreditation, and regulatory requirements to determine the appropriateness and authorization of clinical services, both medical and behavioral health.
• Determine medical necessity and appropriateness referencing regulatory mandates, benefit information, clinical guidelines, and medical references.
• Research and analyze pertinent diseases, treatments, and emerging technologies to support decisions and recommendations to medical directors.
• Collaborate with medical directors, provider and member services, sales, and marketing to ensure appropriate benefit application.
• Make appropriate referrals and contacts, assess alternative care settings, and provide educational presentations on cases and treatment modalities.

Requirements

• Master’s Degree in Psychology or Social Work
• Minimum 5 years of clinical experience
• 2 years of Care Management experience preferred
• Licenses: LCPC or LCSW-C in MD, DC, or VA
• Effective written and interpersonal communication skills
• Strong assessment skills and ability to rapidly connect with members telephonically
• Proficiency with web-based technology and Microsoft Office applications
• Knowledge of managed care, behavioral health delivery systems, and healthcare payer guidelines
• Experience in treatment of substance use and mental health disorders
• Ability to handle confidential data and PHI, prioritize workload, and multitask effectively

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.