Behavioral Health Care Coord (Utilization Management)
This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute in-patient to out-patient office visits.
•Registered Nurse (RN) with current license or Masters-level Behavioral Health Professional with current license to practice at the independent practice level. Current clinical license in state of operations and in good standings.
•3 years clinical experience in psychiatric setting or own behavioral health practice.
•Verbal and written communication skills.
•Analytical and decision making skills.
•PC and database experience.
•Willingness and ability to travel to assigned locations.
PREFERRED JOB REQUIREMENTS:
•Care Coordination Experience
•Utilization review experience.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Behavioral Health, Nursing Job Type Full-Time Regular Location NM - Albuquerque
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