Behavioral Health Utilization Specialist

Ampcus, Inc; Columbia (MD); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Group term life insurance

401(k) retirement savings

Job summary

Ampcus Inc. is seeking a Behavioral Health Utilization Management Specialist to perform prospective, concurrent and retrospective reviews for authorization and benefit coverage.

The role requires clinical expertise to assess appropriateness of medical and behavioral health services and to contribute to care decisions. The position involves analyzing contracts, mandates and medical policy, and working with medical directors to determine necessity and authorization.

Qualifications

• Master's degree in Psychology or Social Work.
• 5 years of clinical experience; 2 years in care management preferred.
• Licensed in MD, DC or VA as LCPC or LCSW-C.
• Excellent written and interpersonal communication skills.
• Proficient in Microsoft Office applications (Word, Excel, PowerPoint).

Responsibilities

• Determine medical necessity and appropriateness by referencing mandates, contracts, benefits and references.
• Research relevant diseases, treatments and technologies to support decisions.
• Make referrals and assist members/providers with alternative care settings.

Skills

Clinical experience

Care management

Licensed LCPC/LCSW-C

MS Office

Education

Master's degree in psychology or social work

Tools

Microsoft Office

Job description

Ampcus Inc. is seeking a Behavioral Health Utilization Management Specialist to perform prospective, concurrent and retrospective reviews for authorization and benefit coverage.

The role requires clinical expertise to assess appropriateness of medical and behavioral health services and to contribute to care decisions. The position involves analyzing contracts, mandates and medical policy, and working with medical directors to determine necessity and authorization.