Behavioral Health Care Coordinator (Utilization Management)
This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members, reviewing medical records, reviewing cases which involve 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 inpatient. In conjunction with other clinical resources, this position assists in the assessment, planning, facilitating, coordinating, monitoring, evaluating, and advocating for options and services required to meet an individual's and family's comprehensive health needs; promote quality, cost effective outcomes; serving as liaison to providers, physicians, and members.
•Registered Nurse (RN) with active, current license or Masters-level Behavioral Health Professional with active, current license to practice at the independent practice level. Current clinical license to practice in state of operations and in good standing.
•3 years of clinical experience in psychiatric setting or own behavioral health practice.
•Verbal and written communication skills.
•Analytical and decision making skills.
•PC and database experience.
•Current drivers license and transportation
•Ability and willingness to travel to assigned locations
PREFERRED JOB REQUIREMENTS:
•Familiarity with ancillary services, for example, wellness or community-based programs (housing, family support services)
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 Job Type Full-Time Regular Location NM - Albuquerque
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