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PA Health & Wellness · 2 days ago

Supervisor, Behavioral Health Utilization Management

Texas, United States

Full-time

Hybrid

Mid, Senior Level

$75K/yr - $135K/yr

4+ years exp

PA Health & Wellness is a diversified national organization that offers competitive benefits and workplace flexibility. The Supervisor of Behavioral Health Utilization Management is responsible for overseeing the behavioral health utilization review clinicians and ensuring compliance with care standards while managing the day-to-day activities of the team.

FitnessHealth CareWellness

Comp. & Benefits

Responsibilities

Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team

Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines

Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards

Works with BH utilization management team to resolve complex BH care member issues related to BH

Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management

Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management

Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers

Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services

Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones

Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required

Assists with onboarding, hiring, and training BH utilization management team members

Attends company meetings in absence of people leader

Acts as primary contact for escalated calls/issues that require research or special handling

Leads and manage others in a matrixed/cross functional environment

Leads and champions change within scope of responsibility

Presents information and responds to questions from peers, leaders and internal/external customers

Performs other duties as assigned

Complies with all policies and standards

Qualification

Behavioral Health experienceUtilization Management knowledgeSupervisory experienceClinical knowledgeLCSWLPCLMFTRNCoaching skillsCommunication skillsProblem-solving skills

Required

Applicants MUST be fully licensed and approved for the state of Texas

Requires a Master's degree or Graduate of an Accredited School of Nursing +4 years of Behavioral Health /Psychiatric related experience

License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required

Knowledge of Utilization Management

Prior supervisory experience

Understanding of medical necessity criteria

LCSW- License Clinical Social Worker required or

LPC - Licensed Professional Counselor required or

LMFT - Licensed Marital and Family Therapist required or

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Preferred

Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred

Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse

Experience working with providers and healthcare teams to review care services, precertification, concurrent review, discharge reviews for mental health and substance abuse cases

Direct IOP Behavioral Health and/or SUD inpatient hospital experience

Direct work experience in Behavioral Health UR, UM, or CM in Managed Care Organizations, In-Patient Behavioral Health Units, Partial Hospitalization, or Residential Treatment

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible approach to work with remote, hybrid, field or office work schedules

Company

PA Health & Wellness

Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).

Founded in 2016

Camp Hill, Pennsylvania, USA

501-1000 employees