Company: Centene Corporation
Posted on: August 17, 2019
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
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
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
Participate in quality improvement activities, supporting network
development and interfacing with treatment facilities and the
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
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, Harrisburg , Utilization Manager, Executive , Harrisburg, Pennsylvania
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