Description
Job Summary
The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Utilization Management Behavioral Health Professional 2 completes telephonic and/or electronic reviews with the Utilization Reviewer at the Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination. This individual will utilize behavioral health knowledge and skills to work with identified members to assess their care needs, assist in planning and implementing interventions to meet those needs, assist in coordinating services, and monitoring and evaluating the case management plan against the member's personal health care goals. In this role, you will:
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