Behavioral Health Utilization Management Specialist - Remote in Indiana

Ideal candidate will have Behavioral Health experience in a health care setting and or Utilization Review Case Management. This is a full-time position Monday-Friday 8am-5pm. The pay for the role is $80,000/yr. This position is primarily provider facing.

· Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.

· Refers cases to Peer Reviewers as appropriate.

· Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes

· Optimize member health benefits and to promote effective use of health benefits and community resources.

· Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment.

o or any combination of education and experience which would provide an equivalent background.

· Current active unrestricted license, such as RN LCSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.

· Licensure is a requirement for this position. However, for states that do not require licensure a Board-Certified Behavioral Analyst (BCBA) is also acceptable if all the following criteria are met:

o performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.

Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.