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Utilization Manager - RN (Sign-On Bonus)

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Company: Centene

Location: Sunrise, FL

Date Posted: September 7, 2014

Source: Centene Corporation

More than healthcare, More than a job, More than a workplace. Want More?

Cenpatico is dedicated to Improving Lives and that starts with hiring top talent like YOU!

Cenpatico is a place where creativity and new ways of thinking and ideas thrive. We make a difference through our people. Our staff have innovative ideas, a passion for serving our members, and develop strong community partnerships.

We are looking for dynamic and talented individuals to join the organization who want to make a difference in the lives of others. We want to hear from you. Tell us how your passion and experiences can help us improve lives each day.

Cenpatico offers exciting and rewarding careers with excellent benefits and a very competitive compensation package.

We are also offering a Sign-On Bonus for this position.

Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided ...

More than healthcare, More than a job, More than a workplace. Want More?

Cenpatico is dedicated to Improving Lives and that starts with hiring top talent like YOU!

Cenpatico is a place where creativity and new ways of thinking and ideas thrive. We make a difference through our people. Our staff have innovative ideas, a passion for serving our members, and develop strong community partnerships.

We are looking for dynamic and talented individuals to join the organization who want to make a difference in the lives of others. We want to hear from you. Tell us how your passion and experiences can help us improve lives each day.

Cenpatico offers exciting and rewarding careers with excellent benefits and a very competitive compensation package.

We are also offering a Sign-On Bonus for this position.

Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects.

Position Responsibilities:

* Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
* Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
* Interact with physicians and social workers for discharge planning.
* Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
* Compile and report daily review activity and facility statistics.
* Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
* Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
* Track benefit usage and advise appropriate parties of exhaustion of benefits.
* Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.

Qualifications

Knowledge/Experience: Masters degree in Behavioral Health or Registered Nurse required. Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN with minimum of 3 years experience in psychiatric and/or substance abuse health care settings including utilization review. Knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.

License/Certificates: Unrestricted license as a LCSW, LMFT, PhD, PsyD or RN

Job
: Clinical & Nursing

Primary Location
: USA-Florida-Jacksonville

Other Locations
: USA-Florida-Sunrise

Organization
: Cenpatico National

Schedule
: Full-time

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