Behavioral Health Utilization Management Jobs in Texas

Two or more years of behavioral health experience.

Strong problem solving skills and decision making skills.

This position requires residency in the state of North Carolina.

Current active professional licensure required in North Carolina: LCMHC, LCSW, RN

Proficiency in Microsoft Office, including Word, Excel and Outlook is required.

Ability to communicate in a positive/professional manner both orally and written.

Coordinate utilization management reviews for all assigned inpatient, partial hospitalization and intensive outpatient program patients.

Coordinates closely with Director of Utilization Management, Nursing and Clinical Services.

Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.

Obtains authorizations for services, coordinates peer-to-peer reviews for assigned caseload.

Understands medical necessity criteria and facilitates accurate and timely documentation to support advocacy of services.

Master’s Degree in Social Work, Marriage and Family Therapy or Counseling from an accredited school or BSN, RN

Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.

1 year of managed care experience working directly with insurance companies

Complete additional responsibilities as deemed appropriate by Humana leadership

Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)

Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote

Behavioral Health direct patient care experience preferred

Applies project management skills by developing and implementing new initiatives.

Identifies strategies to improve health care resource management and communicates to internal and external customers.

Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.

Performs other duties and functions as assigned by management.

Experience in interpreting health plan benefit plans

Basic familiarity with Managed Care legislation, NCQA, and Federal and State regulatory requirements

Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.

1 year of managed care experience working directly with insurance companies

Complete additional responsibilities as deemed appropriate by Humana leadership

Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)

Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote

Behavioral Health direct patient care experience preferred