Utilization Review Care Manager - DC in Washington, DC at Beacon Health Options

Date Posted: 2/18/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Utilization Review Clinician to join our team at our office in the DC area!  The Utilization Review Clinician will be responsible for authorizing and reviewing utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, assisting with discharge planning and ambulatory follow up activity, maintaining phone coverage for Trusted Account Call Center, providing member assistance with mental health and substance abuse issues, and participating in special utilization projects.

Position Responsibilities:

  • Determines appropriate level of care related to mental health and substance abuse treatment for members based on Beacon’s medical necessity criteria
  • Analyzes specific utilization problems, and plans and implements solutions that directly influence quality of care and financial liability
  • Interacts with physicians and other members of the provider clinical team for discharge planning
  • Performs telephonic case review for pre-admission and continuing care in psychiatric and substance treatment facilities as assigned
  • Provides telephone triage, crisis intervention and emergency authorizations as assigned
  • Performs concurrent reviews for inpatient care and other levels of care as allowed by scope and practice and experience
  • Provides information to members and providers regarding mental health and substance abuse benefits, and community treatment resources

Position Requirements:

  • Education: Master’s degree or higher in a health related field and independent licensure as a behavioral health professional or BSN, independent licensure as a professional required.
    • Utilization Review clinicians are required to be educated in current principles, procedures and knowledge of behavior health.
  • Licensure:  Must be a licensed behavioral health clinician and practice within the scope of their licensure in DC.
  • Relevant Work Experience: 2 years’ of behavioral health experience, managed care experience preferred
  • Knowledge, Skills & Abilities:
    • Communicate effectively in both verbal and written form, as well as an ability to be clear and concise in all communications.
    • Proven ability to work both independently and in a team structure.

To Apply:

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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled