Temporary Remote Behavioral Health Utilization team member needed for special project with health insurance company through May.

Required Qualifications:

--Must have a current, unrestricted LAC, LPC, LMFT or LCSW in Colorado with psychiatric and substance use treatment experience

--4 or more years directly serving individuals with mental health / substance use disorders

--1 or more experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc.)

--1+ years of experience with MS Office, including Word, Excel, and Outlook

--Must have strong attention to detail and time management skills

--Position is remote, must have reliable internet and quiet workspace

Preferred Experience:

--1+ years of utilization management experience

--Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)

--Experience working in team-based care

--Experience working in a busy, fast paced environment

--Experience working with multiple systems to complete a job

--Background in Managed Care working with the Medicaid population

--Demonstrated knowledge of substance use and behavioral health service delivery systems emphasizing time-efficient models of intervention

--Knowledge of the Colorado behavioral healthcare system, particularly acute care facilities

Job Duties:

--Provide members and providers consultation on a variety of issues including benefit information, safety issues, confirmation of prior authorizations and approvals, procedures for higher levels of care evaluations, and request for an explanation of the level of care, coverage determination, or best practice guidelines

--Respect confidentiality and HIPAA

--Support outcome focused, evidence-based best practices and guidelines with providers

--Establish and maintain professional working relations with referral sources, community resources, and care providers and be able to identify and communicate network gaps

--Appropriately identify the need for higher level reviews such as staffing, peer review, or MD consultation. Formulate concise case overviews

--Process pre-authorization and notification of inpatient and other treatment services

--Oversee initial inpatient admission for psychiatric and chemical dependency patients and provide concurrent review of inpatient and other treatment services

--Conduct patient assessments and determine appropriate levels of care

--Administer benefits, review treatment plans, and coordinate transitions between various areas of care

--Obtain information from providers on outpatient requests for treatment

--Work with consumers and providers to identify and help fill gaps in care and to help consumers move through the continuum of care as appropriate

--Handle escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate

--Utilize individual thought to organize and validate data and develop reports s (e.g., production reports, utilization reports, compliance reports for internal and external audits, and validation of bed days per thousand)

--Utilize clinical knowledge and critical thinking to apply evidence-based guidelines to clinical scenarios to determine medical appropriateness and appropriate level of care

If qualified, please apply via the link or email your resume to jobs.grandjunctionco@expresspros.com