Remote Behavioral Health Utilization RN

Community Health Choice, Inc.; Houston (TX); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Behavioral Health Utilization Manager to perform concurrent and discharge reviews, applying approved criteria to justify admission and ongoing care.

The role requires timely communication with the Medical Director and ongoing data tracking for reporting and trend analysis. Ideal candidates hold a Bachelor’s in nursing with an active RN license and at least two years in acute psychiatric care plus utilization/review in managed care settings

Qualifications

• Bachelor's degree in nursing required.
• Current state RN license required.
• Two years' experience in an acute psychiatric care setting required.
• Two years' experience in utilization and appeal review in a managed care environment (Medicaid/Medicare) required.

Responsibilities

• Perform concurrent and discharge reviews on assigned patients and justify admission and continued stay using approved criteria.
• Notify Medical Director regarding reviews of medical records for peer-to-peer reviews.
• Utilize nationally recognized evidence-based clinical criteria and company policies.
• Enter required information into the managed care platform adhering to UM and Appeals policies.
• Assist in coordination of care for hospitalized and medically complex members and participate in discharge planning.

Skills

Critical thinking

Independent worker

Team collaboration

Attention to detail

Education

Bachelor's degree in nursing

Registered Nurse license

Tools

MS Word

MS Excel

Outlook

Job description

Community Health Choice, Inc. is seeking a Behavioral Health Utilization Manager to perform concurrent and discharge reviews, applying approved criteria to justify admission and ongoing care.

The role requires timely communication with the Medical Director and ongoing data tracking for reporting and trend analysis. Ideal candidates hold a Bachelor’s in nursing with an active RN license and at least two years in acute psychiatric care plus utilization/review in managed care settings