Remote Behavioral Health Utilization Manager

Harris Health; Houston (TX); Remote; USD 85,000 - 105,000; Full time

Job summary

Community Health Choice is seeking a Behavioral Health Utilization Manager with nursing credentials to conduct concurrent and discharge reviews using established criteria for admission and ongoing care. You will communicate outcomes to providers and support data tracking for trending and reporting.

The role requires RN licensure and experience in psychiatric/managed care settings, with remote work arrangements and strong clinical decision-making skills.

Qualifications

• Bachelor's degree in nursing.
• Current state RN license.
• Two years' experience in an acute psychiatric care setting.
• Two years' experience in utilization and appeal review in a managed care environment with Medicaid/Medicare.
• Computer literacy: MS Word, MS Excel, Outlook and telephone systems.

Responsibilities

• Performs concurrent and discharge reviews using approved criteria for admission and continued stay.
• Notifies Medical Director regarding peer reviews of records submitted by providers.
• Maintains required data in the managed care platform and reporting databases.
• Coordinates care for hospitalized and medically complex members as applicable.

Education

Bachelor's degree in nursing

Current state RN License

Tools

MS Word

MS Excel

Outlook

Telephone systems

Job description

Community Health Choice is seeking a Behavioral Health Utilization Manager with nursing credentials to conduct concurrent and discharge reviews using established criteria for admission and ongoing care. You will communicate outcomes to providers and support data tracking for trending and reporting.

The role requires RN licensure and experience in psychiatric/managed care settings, with remote work arrangements and strong clinical decision-making skills.