Health Services - Spec, Utilization Management

Ampcus, Inc; Columbia (MD); In loco; USD 90.000 - 120.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, dental, and vision insurance

Group term life insurance

401(k) retirement savings

Descrizione del lavoro

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.

Competenze

• 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).

Mansioni

• 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.

Conoscenze

Clinical experience

Care management

Licensed LCPC/LCSW-C

MS Office

Formazione

Master's degree in psychology or social work

Strumenti

Microsoft Office

Descrizione del lavoro

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.