Remote Behavioral Health Utilization Manager RN

Harris Health; Houston (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Harris Health affiliate Community Health Choice is seeking a Behavioral Health Utilization Manager to perform concurrent and discharge reviews, applying approved criteria for admission and continued stay, and notifying the Medical Director with review outcomes.

You will coordinate care, assist in discharge planning for psychiatric levels of care, document findings in the managed care platform, and help ensure timely, quality determinations in a remote work setting.

Qualifications

• Education/Licensure: Bachelor\'s degree in nursing and current state RN 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.
• Computer literate with knowledge of MS Word, MS Excel, Outlook, and telephone systems.

Responsibilities

• Verifies member eligibility, benefit coverage and facility contract status prior to processing authorization requests.
• Reviews telephonic and faxed clinical information to authorize medically necessary inpatient and outpatient care.
• Enter required information into the managed care platform, adhering to UM policies and procedures.
• Meets performance metrics and quality standards for reviewed cases within turnaround times.

Skills

RN license

psychiatric care

utilization review

Medicaid/Medicare knowledge

critical thinking

Education

Bachelor's degree in nursing

Tools

MS Word

MS Excel

Outlook

Job description

Harris Health affiliate Community Health Choice is seeking a Behavioral Health Utilization Manager to perform concurrent and discharge reviews, applying approved criteria for admission and continued stay, and notifying the Medical Director with review outcomes.

You will coordinate care, assist in discharge planning for psychiatric levels of care, document findings in the managed care platform, and help ensure timely, quality determinations in a remote work setting.