Remote Behavioral Health Utilization & Appeals Manager

Harris Health System, Inc.; Houston (TX); Hybrid; USD 85,000 - 120,000; Full time

Job summary

Community Health Choice, Inc. seeks a Behavioral Health Utilization Manager to perform concurrent and discharge reviews for assigned patients.

You will apply approved criteria for admission and continued stay, notify the Medical Director, and provide timely outcomes to providers per State policy. Responsibilities include data management for tracking, trending, and reporting cases, coordinating with the Medical Director and Complex Case Management Team as needed, and contributing to department

Qualifications

• Bachelor's degree in nursing is required.
• Current state Registered Nurse License.
• Two (2) years' experience in an acute psychiatric care setting.
• Two (2) years' experience in utilization and appeal review in a managed care environment with Medicaid and Medicare members.

Responsibilities

• Perform concurrent and discharge reviews on assigned patients and justify admission and continued stay using approved criteria.
• Notify Medical Director regarding peer to peer reviews and provide timely outcomes to providers in line with State policy.
• Assist in development and maintenance of a database for tracking, trending and reporting of cases.

Education

Bachelor's degree in nursing

Tools

MS Word

MS Excel

Outlook

Job description

Community Health Choice, Inc. seeks a Behavioral Health Utilization Manager to perform concurrent and discharge reviews for assigned patients.

You will apply approved criteria for admission and continued stay, notify the Medical Director, and provide timely outcomes to providers per State policy. Responsibilities include data management for tracking, trending, and reporting cases, coordinating with the Medical Director and Complex Case Management Team as needed, and contributing to department