Utilization Management Behavioral Health

Job DescriptionThis position is a hybrid role that combines the roles and expertise of Utilization Review and Care Management. It ensures that members receive high-quality, cost-effective care, focusing on medical necessity, cost monitoring, and member safety. The ideal candidate possesses a strong understanding of utilization management principles and a solid foundation in healthcare operations and regulatory compliance.In this role, candidates will apply expertise to review medical records and treatment plans for individuals with specific conditions or diagnoses, including medical and behavioral health conditions, to ensure services are medically necessary, appropriate, and cost-effective.To show our commitment to you and help with your transition into our organization, we will offer a $2500 sign-on bonus to those with 1+ year of experience. External LCSW applicants only.Job SpecificsPay Range LCSW: $38.77 - $59.82 ExemptPay Range RN: $40.39 - $60.96 ExemptBenefits Eligible: YesFTE: Full timeShift: Hybrid Role. Monday - Friday, 8:00am - 4:30pm. Occasional weekends and holidays.Click learn about additional Intermountain benefitsREQUIRED LCSW or RN LicensureEssential FunctionsUtilization Review and Care Management of members with specific treatment plans, conditions, or diagnosis, including medical and behavioral health conditions.Provide ongoing training and support to families and caregivers.Collect, analyze, and interpret data to evaluate the effectiveness of interventions.Stay current with the latest research and best practices in assigned population.Inform Select Health Medical and Behavioral Health policy and procedure.Peer to Peer and Peer review to evaluate and influence the work of others in the field to ensure adherence to ethical standards, best practices, and regulatory requirements.Occasional travel to provider locations within Select Health region.Review medical records to determine the medical necessity of services.Evaluate the appropriateness of procedures, diagnostic assessments, functional behavior assessments, and treatment plans.Make timely and informed determinations about the medical necessity and appropriateness of services.Adhere to regulatory requirements, payer guidelines, and ethical standards.Facilitate communication, organize collaborative meetings, and resolve conflicts with healthcare providers to ensure coordinated member care.Communicate with members, families, and insurance representatives.Conduct comprehensive assessments of members' needs.Develop and implement individualized care plans.Educate and empower members and families.Advocate for members' rights and access to care.Monitor and evaluate the effectiveness of care plans.Minimum QualificationsMaster's degree in Applied Behavior Analysis (BCBA) or Licensed Clinical Social Work (LCSW)Current licensure or Certification in Utah: BCBA, LCSW or RNCurrent RN (Nurse) compact license to practice in all states that are part of the compact; may be asked to obtain additional state licenses as needed in Select Health RegionsMay be required to obtain licensure in other states in Select Health region within 90 days of employmentDemonstrated clinical expertise and experience in related behavioral health fieldMinimum 1 year experience in Utilization Management or closely related field, including Utilization Review, Case Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator rolesIntermediate computer and hardware set-up, ability to customize computer settings and use multiple monitors, and capable of independent troubleshooting of internet and applicationsPreferred QualificationsThree years of experience and expertise working in clinical Behavioral Setting or Utilization ManagementAbility to work independently and be flexible in a rapidly changing environmentDemonstrated excellent written and verbal communication skillsExperience working successfully in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & OutlookAbility to travel as neededKnowledge of healthcare insurance and utilization review processesKnowledge of regulatory requirements, such as NCQA, CMS, and state-specific regulations and legislation related to the fieldPhysical RequirementsOngoing need to see and read information, documents, monitors, and identify equipment and supplies; assess customer needsFrequent interactions with colleagues and providers requiring verbal communication and attentive listeningManual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy, including frequent computer use for typing and accessing informationMay be expected to sit or stand in a stationary position for an extended period of timeLocationSelectHealth - MurrayWork CityMurrayWork StateUtahScheduled Weekly Hours40Hourly Range$38.77 - $59.82We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness encompassing living healthy, happy, secure, connected, and engaged.Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment.All positions subject to close without notice.#J-18808-Ljbffr