Manager, Behavioral Health Utilization Management Remote

Primary City/State:

Tucson, Arizona

Department Name:

Behavioral Health

Work Shift:

Day

Job Category:

Clinical Care

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY
This position provides oversight of the utilization review, prior authorization and care management staff and activities as directed by the Manager or Director of Behavioral Health Medical Management. Hires, trains and develops staff, evaluates performance and makes recommendation for improvement. Provides leadership and guidance to staff and management.

CORE FUNCTIONS
1. Leads and manages prior authorization, concurrent review, retrospective review and care management staff within Medical Management. Ensures quality of service and consistency is maintained. Develops workflows and processes that support accurate and timely responses to issues.

2. Participates in hiring, orientation, training and development of staff within the Medical Management Programs. Evaluates performance and makes recommendations for improvement.

3. Communicates with PA, CM and UM departmental staff and management to ensure implementation of new desk top procedures and policies to comply with AHCCCS and CMS requirements and Health Plan goals. Develops work standards for area functions. Monitors processes and implements changes as needed for efficiency.

4. Collaborates with Management staff and Medical Directors to review cases and data for appropriateness of care, resource care, and achievement of budgetary targets.

5. Conducts audits and routine performance reviews.

6. Participates in or coordinates rounds, departmental meetings, quality teams, and other committees to ensure collaboration with other departments and compliance with State mandates.

7. Participates in provider and staff education/training/presentations.

8. Performs other related duties, including on-call, as assigned, and which are consistent with the goals and qualifications of this position.

9. This position may supervise others in the medical management systems of prior authorization and case management. Internal customers include medical directors, medical management, medical claims review, risk adjustment, and denials. External customers may include community providers, hospitals, and health plan members. The incumbent conducts himself/herself to favorably represent the health plan in a variety of activities.

MINIMUM QUALIFICATIONS

Must possess knowledge of utilization review as normally obtained through the completion of a bachelor's or master’s degree in health care.

Active independent behavioral health license with the Arizona Board of Behavioral Health Examiners ( LPC, LMFT, LCSW, LMSW, LAC, or Licensed Psychologist (Phd, PsyD) or RN with experience in behavioral health with a license permitting work in the State of Arizona.

Three years of clinical experience in prior authorization, utilization review, or care management, with one year of experience in a lead, supervisory, or management role. Knowledge of utilization management data analysis. Knowledge of Medicare, Medicaid, and Managed Care, CPT, ICD-10, DSM 5 and HCPCS codes. Skill in preparing and presenting detailed information to ensure understanding for a wide audience base. Skill in organizing work and providing critical thinking to resolve problems. Skill in communicating with all levels of the organization. Skill in conducting utilization data analysis and providing recommendations. Skill in oral and written communication. Ability to organize and execute programs. Ability to work independently to identify, develop, monitor, evaluate, and report on projects Ability to perform ongoing and objective projects ensuring all deadlines are met. Ability to be flexible in order to work on a variety of initiatives simultaneously under tight time constraints. Ability to build and maintain professional working relationships with all levels of support staff, providers, administrative staff and all internal and external customers.

Skill in computer applications including Microsoft Office Products and medical management systems.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Privacy Policy