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Job Summary

This position is responsible for supervising staff involved in Behavioral Health Care Utilization Management (UM) including Preauthorization, Concurrent, and Retrospective Review-- while abiding by all contractual and accreditation requirements. This position collaborates with providers to ensure services are rendered in a cost-effective manner while meeting the member’s health needs within the scope of their benefit plan. This position is responsible for assisting in developing and implementing Behavioral Health Care Policies, Procedures and Initiatives related to Behavioral Health Utilization Management Services, which includes operationalizing, monitoring and assisting the utilization management team in achieving departmental targets and goals-- evidencing optimal people/leadership skills.

Required Job Qualifications:

• Registered Nurse (RN) with current, valid license in good standings or Masters-level Behavioral Health Professional with current, valid license in good standings to practice at the independent practice level in the state of Texas.
• 3 years clinical experience in psychiatric setting or own behavioral health practice.
• 3 years behavioral health utilization review or behavioral health Utilization management experience.
• Knowledge of medical terminology.
• Knowledge of accrediting agency standards and regulations.
• Knowledge of behavioral health products, processes, community services and trends.
• Leadership skills.
• Project management skills.
• Verbal and written communication skills.
• Analytical and decision making skills.
• PC and database experience.

Preferred Job Qualifications:

• Preferred location at least 60 miles within the Albuquerque, NM & Chicago IL. offices.

• Some travel required.

This is a Telecommute (Remote) role:Must reside within 250 miles of the office or anywhere within the posted state.

*CA

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$67,500.00 - $143,100.00