Utilization Management Clinician

This is a fully remote position, open to applicants in Florida.

📋 Description

• Work collaboratively with physicians, nurses, social workers, and a diverse array of medical and non-medical professionals to ensure the effective delivery of healthcare services.

• Evaluate the specific health plan benefits available to members along with additional medical, community, or financial resources.

• Deliver utilization management (UM) services that foster quality, cost-effective outcomes by assisting member populations in achieving optimal utilization of healthcare services.

• Enhance member care through the implementation of fiscally responsible strategies.

• Gather and evaluate member information relevant to their history, condition, and functional capabilities to encourage wellness, appropriate utilization, and cost-efficient care and services.

• Organize essential resources to meet member outcome goals and objectives.

• Accurately document case notes and explanatory letters that may be included in legal records.

⛳️ Requirements

• A minimum of three (3) years of nursing or behavioral health experience with a variety of medical and/or behavioral health exposure and skills is required.

• Preferred experience includes acute care, case management, rehabilitation, home health, behavioral health, and hospice treatment.

• An active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner (PMHNP) credential is required.

• Case Manager Certification accredited by CCMC is preferred.

• Comprehensive knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, and procedure codes, including ICD and CPT Codes, as well as health insurance and state-mandated benefits.

• Familiarity with contractual benefits and options available beyond those benefits.

• Proficient in utilizing computerized systems for data documentation and retrieval.

• Ensures patient confidentiality, privacy, and security of health records.

• Maintains an up-to-date clinical knowledge base and certification.

• Capable of working independently with minimal supervision.

🏝️ Benefits

• Flexible telecommute policy.

• Medical, vision, and dental insurance.

• Incentive program.

• Paid time off and holidays.

• 401(k) plan.

• Volunteer opportunities.

• Tuition reimbursement and training.

• Life insurance.

• Options such as a flexible spending account.