Health Services - Spec, Utilization Management

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

Benefits offered by this job

Health & Wellness insurance

Life Insurance

Retirement Savings: 401(k)

Job summary

Ampcus Inc. is seeking a Behavioral Health Utilization Management Specialist to perform prospective, concurrent and retrospective reviews for authorization and appropriateness of care in medical and behavioral health services.

The position requires a Master’s in Psychology or Social Work, MD/DC/VA LCPC or LCSW-C licensure, 5 years of clinical experience, and strong written/interpersonal communication skills. Proficiency in MS Office is expected.

Qualifications

• Master’s degree in Psychology or Social Work is required.
• Minimum 5 years of clinical experience; 2 years in care management preferred.
• MD/DC/VA licensure as LCPC or LCSW-C required.
• Strong written and interpersonal communication skills.
• Proficient with Microsoft Office (Word, Excel, PowerPoint).

Responsibilities

• Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and accepted medical references.
• Conduct research and analysis of pertinent diseases, treatments and emerging technologies to support decisions and recommendations to medical directors.
• Make appropriate referrals and contacts as appropriate; offer assistance to members and providers for alternative care settings.

Skills

Written communication

Interpersonal communication

Regulatory knowledge

Clinical utilization management

Education

Master’s Degree in Psychology or Social Work

Tools

Microsoft Office

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title

Health Services - Spec, Utilization Management

Location(s)

MD, DC, or VA

Job Summary

Utilizing key principles of utilization management, the Behavioral Health Utilization Management Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Behavioral Health Utilization Management Specialist will analyze clinical information, contracts, mandates, medical policy, evidence-based published research, national accreditation and regulatory requirements to contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.

Key Responsibilities

• Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and accepted medical/pharmaceutical references.
• Conduct research and analysis of pertinent diseases, treatments and emerging technologies to support decisions and recommendations made to the medical directors.
• Make appropriate referrals and contacts as appropriate. Offer assistance to members and providers for alternative settings for care.

Required Qualifications

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

Benefits Overview

• Health & Wellness: Comprehensive pre-tax health, dental, and vision insurance options.
• Life Insurance: Group term life insurance and voluntary life insurance coverage.
• Retirement Savings: 401(k) retirement savings plan to help you plan for your future.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.