Utilization Management Behavioral Health Professional

This is a fully remote position, open to applicants in South Carolina, +3 more states.

📋 Description

• Applies behavioral health expertise and skills to assist in the coordination, documentation, and communication of medical services and/or decisions related to benefit administration.

• Work assignments vary significantly and often necessitate interpretation along with independent judgment to determine suitable courses of action.

• Leverages clinical knowledge, communication abilities, and independent critical thinking to interpret criteria, policies, and procedures, ensuring the delivery of the most effective treatment, care, or services for members.

• Engages in coordination and communication with providers, members, or other stakeholders to promote optimal care and treatment.

• Comprehends departmental, segmental, and organizational strategies and operational objectives, including their connections to related areas.

• Exercises decision-making regarding personal work methods, sometimes in ambiguous scenarios, requiring minimal direction while seeking guidance when necessary.

⛳️ Requirements

• Must fulfill one of the following: possess an active unrestricted registered nurse license in the state of Virginia, or obtain a multi-state license in a participating state of the enhanced compact licensure (eNLC), with experience in Behavioral Health (e.g., inpatient psychiatric care, substance use treatment, or other Behavioral Health treatment environments).

• Hold an active unrestricted LCSW, LPC, LMFT, or LCP, or be a Licensed Clinical Psychologist permitted to practice as a health professional in the state of Virginia.

• A minimum of one (1) year of post-degree clinical experience in private practice or another clinical patient care setting is required.

• At least one (1) year of experience in managed care is necessary.

• Intermediate to advanced proficiency in Microsoft Office Word, Excel, PowerPoint, and navigation of multiple systems and platforms is essential.

• Capability to troubleshoot and resolve basic technical issues in a remote setting.

• Ability to work autonomously under general instructions as well as collaboratively within a team.

• Strong oral, written, and interpersonal communication skills, along with problem-solving and facilitation abilities.

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Time off options including paid time off, company and personal holidays, as well as paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Competitive benefits that foster whole-person well-being.