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Manager, Utilization Management – MSL/RN, Behavioral Health
Job Description: • Oversee all behavioral health utilization management activities ensuring consistency of services and achievement of utilization targets • Assist in coordination and management of the pre-determination process of behavioral health services • Ensure the consistent application of criteria for authorization decision • Interact with providers and staff to manage benefits aligned with state-based regulations • Review and revise workflows to maximize efficiencies • Monitor productivity and utilization trends • Oversee CQI activities and ensure audits and staff feedback occur at regular intervals • Regularly report all utilization management regulatory requirements • Ensure compliance with and reporting of all regulatory requirements • Maintain all behavioral health utilization management reporting and trend data • Analyze under and over utilization information for impact on member quality of care and outcomes • Develop, maintain and update all departmental policies and procedures Requirements: • Associates degree in Nursing, behavioral health or related field required • Bachelor's degree preferred • Five (5) years of clinical experience required • Five (5) years of experience in behavioral health, case management, utilization management, and/or quality improvement required • Two (2) years utilization management experience preferred • Managed Care experience preferred • One (1) year Leadership experience required • Beginning Excel, Word and PowerPoint experience • Experience in data analysis and trending • Knowledge of utilization management standards and practices • Ability to work independently and within a team environment • Attention to detail • Familiarity of the health care field • Critical listening and thinking skills • Training/teaching skills • Strategic management skills • Negotiation skills/experience • Technical writing skills • Time management skills • Proper phone etiquette • Customer service oriented • Decision making/problem solving skills • Leadership experience and skills Benefits: • Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Bonuses Apply tot his job
