ConwayRecruiter Since 2001
the smart solution for Conway jobs

Utilization Manager

Company: Centene Corporation
Location: Conway
Posted on: August 16, 2019

Job Description:

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.

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.
Education/Experience: Master's degree in Behavioral Health or RN. 3+ years experience in psychiatric and/or substance abuse health care settings including utilization review. Working knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.

License/Certification: Required to have license to practice independently, and/or have obtained the state required licensure as outlined by the applicable state. This includes but is not limited to licenses such as LPC, LCSW, LMFT, LMHC, LIMHP, and RN.

Sunflower Health Plan Only: LCPC, LSCSW, LCMFT, LCP, LCAC, APRN, or PMH-APRN or similar state license required.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Centene Corporation, Conway , Utilization Manager, Executive , Conway, Arkansas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Supervisor, Medical Management (Non-Clinical)
Description: Description: Position Purpose: Supervise the day-to-day operations of the medical review unit Oversee changes
Company: Centene Coproration
Location: Little Rock
Posted on: 08/20/2019

Director of Business Development - Own a Franchise
Description: Director of Business Development:
Company: CMP.jobs
Location: Little Rock
Posted on: 08/19/2019

RN - Quality Management Coord - Full Time Days
Description: POSITION TYPE: Regular SCHEDULED HOURS PER 2 WEEK PAY PERIOD: 80 PRIMARY LOCATION: AR LITTLE ROCK ST VINCENT INFIRMARY JOB SUMMARY: Under the direction of the Service Line Administrator for the Jack (more...)
Company: CHI St. Vincent
Location: Little Rock
Posted on: 08/22/2019


Strategic Account Manager - Top Accounts
Description: Strategic Account Manager -- Top Accounts br br JOB DESCRIPTION: br br At Micro Focus, everything we do is based on a simple idea: The fastest way to get results is to build on what you have. (more...)
Company: Micro Focus
Location: Little Rock
Posted on: 08/22/2019

Internal Medicine Associate Program Director
Description: Medical Director opening in Little Rock, Arkansas. This and other physician jobs brought to you by DocCafe.com Job Description Requirements br Internal Medicine Associate Program Director in Arkansas (more...)
Company: Merritt Hawkins
Location: Little Rock
Posted on: 08/18/2019

DHS Chief Financial Officer
Description: Accounting Manager ARC Document Solutions
Company: ARC Document Solutions
Location: Little Rock
Posted on: 08/23/2019

Director of Operations - Own a Franchise
Description: Directors of Operations: Make
Company: CMP.jobs
Location: Little Rock
Posted on: 08/17/2019

Sales Director - Little Rock, AR
Description: Sales Director - Little Rock, AR Job no: Work type: Full Time Regular Location: Arkansas Categories: Leadership, Sales Oversees the overall sales function for a unit of Advisors through guidance (more...)
Company: Mutual of Omaha (Insurance)
Location: Little Rock
Posted on: 08/17/2019

General Manager - Restaurant
Description: Req ID: 139242Do you want to Fuel Your Career Do you have experience in Quick Service, Fast Food, or Full Service Restaurant management Do you have a proven track record of successful restaurant operations, (more...)
Company: Loves Travel Stops & Country Store
Location: Pine Bluff
Posted on: 08/23/2019

Restaurant Manager
Description: This job opportunity is with one of our many franchisees. Independently owned and operated, Wendy's franchise
Company: Wendy's
Location: Pine Bluff
Posted on: 08/23/2019

Log In or Create An Account

Get the latest Arkansas jobs by following @recnetAR on Twitter!

Conway RSS job feeds