Utilization Management Clinician – Tuesday, Saturday
Job not on LinkedIn
🕒 July 21
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
📋 Description
• Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. • Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available. • Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services. • Facilitate outstanding member care using fiscally responsible strategies. • Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. • Coordinate necessary resources to achieve member outcome goals and objectives.
🎯 Requirements
• Minimum of three (3) years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required. • Experience in acute care, case management, including cases that require rehabilitation, home health, behavioral health and hospice treatment strongly preferred. • Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner, (PMHNP) credential required. • Case Manager Certification as accredited by CCMC preferred. • Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance and state-mandated benefits. • Ability to use computerized systems for data recording and retrieval.
🏖️ Benefits
• Health insurance • 401(k) • Paid time off • Flexible work arrangements
Apply NowSimilar Jobs
🕒 July 21
Utilization Management Clinician collaborating with healthcare professionals to enhance member care and outcomes. Assessing health plan benefits and coordinating healthcare services with a focus on cost-effective solutions.
🕒 July 20
Behavioral Health Clinician performing assessments and care management for Horizon Blue Cross Blue Shield. Evaluating and coordinating behavioral health medical services and ensuring appropriate level of care.
🇺🇸 United States – Remote
💵 $70.5k - $94.4k / year
⏰ Full Time
🟢 Junior
🟡 Mid-level
🚫👨🎓 No degree required
🕒 July 13
Full-time Physician conducting online Video Visits for health plan members, working remotely while engaging with health plan members primarily online.
🕒 July 13
Full-time Physician at CVS Health conducting Video Visits for Medicare Advantage and Medicaid members. Engaging with health plan members and providing care remotely from Indiana.
🕒 July 13
Physician providing Video Visits for Medicare Advantage and Medicaid plan members. Conducting online visits and managing member health effectively from a remote space.
