UM Behavioral Health Nurse
Core
Utilization Management Behavioral Health Professional supporting coordination, documentation, and communication of medical services and benefit administration determinations for members.
Role type
Utilization Management Behavioral Health Professional (RN)
Builds
Treatment, care, and service plans for members
Domain
Healthcare / Behavioral Health / Managed Care
Required skills
Registered Nurse (RN), clinical experience in private practice or patient care, managed care experience, independent critical thinking, interpretation of criteria and policies
Preferred skills
Bachelor's Degree, utilization review process experience, MCG/ASAM/medical policy review experience, behavioral change coaching, older adult population experience, community health resources knowledge, bilingual (English/Spanish)
Technologies
MCG, ASAM
Responsibilities
Coordinate and communicate with providers and members to facilitate optimal care; interpret criteria, policies, and procedures to determine appropriate courses of action; make decisions regarding work methods in ambiguous situations with minimal direction.
Seniority
Mid-level, independent contributor