Utilization Management Case Manager II

healthfirst; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

Healthfirst seeks a skilled Case Manager, Utilization Management, to coordinate care plans, perform pre-certifications and concurrent reviews, and collaborate with providers to maximize quality outcomes and efficient use of health services.

You will document determinations, educate beneficiaries, and support discharge planning while meeting performance metrics and compliance standards.

Qualifications

• Experience in case management within mental/behavioral health or addictions.
• Knowledge of InterQual/Malliman criteria and care-utilization review.
• Ability to document and communicate effectively across clinical teams.

Responsibilities

• Coordinate case management for assigned members and conduct pre-certifications and reviews.
• Identify medical, psychological, and social needs requiring intervention.
• Collaborate with PCPs and providers to coordinate treatments and authorizations.

Skills

Case management

Critical thinking

Documentation

Communication

Education

RN/LPN/LMSW/LMHC/LMFT/LCSW/LPT/OT/ST license

Tools

InterQual

Milliman

Job description

Healthfirst seeks a skilled Case Manager, Utilization Management, to coordinate care plans, perform pre-certifications and concurrent reviews, and collaborate with providers to maximize quality outcomes and efficient use of health services.

You will document determinations, educate beneficiaries, and support discharge planning while meeting performance metrics and compliance standards.