PlanoRecruiter Since 2001
the smart solution for Plano jobs

Behavioral Health Utilization Manager

Company: Centene Corporation
Location: Plano
Posted on: March 29, 2020

Job Description:

Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects. Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care. Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated. Interact with physicians and social workers for discharge planning. Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards. Compile and report daily review activity and facility statistics. Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community. Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient. Track benefit usage and advise appropriate parties of exhaustion of benefits. Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases. Education/Experience: Master’s degree in Behavioral Health or RN. 3+ years experience in psychiatric and/or substance abuse health care settings including utilization review. Working knowledge of utilization review procedures, mental health and substance abuse community resources and network providers. License/Certification: Required to have license to practice independently, and/or have obtained the state required licensure as outlined by the applicable state. This includes but is not limited to licenses such as LPC, LCSW, LMFT, LMHC, LIMHP, and RN. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Centene Corporation, Plano , Behavioral Health Utilization Manager, Other , Plano, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Freelance Copy Editor
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: Rowlett
Posted on: 03/29/2020

Freelance Videographer
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: Wylie
Posted on: 03/29/2020

iLearning Hot Spot Facilitator - IDEA College Prep Achieve (20-21)
Description: Description Position at IDEA Public Schools About IDEA Public Schools At IDEA Public Schools, we believe in college for ALL and we are committed to ensuring that all our students graduate from college. (more...)
Company: IDEA Public Schools
Location: Haltom City
Posted on: 03/29/2020


Freelance Videographer
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: Mansfield
Posted on: 03/29/2020

Freelance Videographer
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: Haltom City
Posted on: 03/29/2020

Freelance Videographer
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: The Colony
Posted on: 03/29/2020

Intensivist - Neuro
Description: Questcare Intensivists, a division of Envision Physician Services, is looking for Neuro Critical Care Intensivists to join our growing team at Medical City Plano, which is situated
Company: Envision Physician Services
Location: Wylie
Posted on: 03/29/2020

Intensivist – Neuro
Description: Questcare Intensivists, a division of Envision Physician Services, is looking for Neuro Critical Care Intensivists to join our growing team at Medical City Plano, which is situated
Company: Envision Physician Services
Location: The Colony
Posted on: 03/29/2020

Freelance Copywriter
Description: Kalo is the leading xHR software used by over 1,700 of the world s most notable brands to manage their freelancer workforce. Kalo.Work is a new initiative that gives freelancers the opportunity to get (more...)
Company: kalo
Location: Haltom City
Posted on: 03/29/2020

Electrical Engineer Writer for EETech
Description: Join Our Remote Team of Consulting Engineer WritersDo you want to be a part of the EETech Writer Team Do you have the technical expertise or experience to develop high-quality content EETech is known (more...)
Company: EETech
Location: The Colony
Posted on: 03/29/2020

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Plano RSS job feeds