Utilization Management Behavioral Health Professional Jobs in Iowa

3+ years of utilization management experience

Provide management of behavioral health services, including crisis assessment and intervention

Administer benefits, review treatment plans, and coordinate transitions between various areas of care

Undergraduate degree or equivalent experience

1+ years of experience with MS Office, including Word, Excel, and Outlook

Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)

Excellent data entry skills and ability to navigate electronic systems applicable to job functions

Ensure all pre-certifications are completed for inpatient and outpatient services

Work with facilities to ensure documentation requirements are met

Interface with managed care organizations, external reviews, and other payers

2 or more years experience billing UR healthcare industry – in the mental health/addiction field.

Working knowledge of clinical case formulation for substance abuse/mental health treatment.

5-8 years post-master’s direct clinical experience, including utilization management in behavioral health or managed care

Provide monthly Care Management report on team(s) performance, metrics, and goal achievement to the Director of Behavioral Health.

Demonstrated understanding and proficiency in the principles, concepts and techniques of managed care and utilization management.

Able to manage ambiguity and change, and lead a team’s effective management of shifting priorities, competing demands, and rapidly changing conditions.

5-8 years of supervisory experience preferred

Experience with Medicare and Medicaid

Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.

Extensive experience in behavioral health strongly preferred.

Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.

Extensive experience working in a highly matrixed environment strongly preferred.

National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

Produces QM documents, including tracking and updating Work Plan activity progress.