Utilization Review Analyst - RN

MRINetwork

New York, New York, United States

New York, New York, United States

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Über

Behavioral Health Case Manager Responsible for providing telephonic and e-referral case review and authorization of services utilizing established mental health and substance abuse medical necessity criteria to provide quality care appropriate to clinical needs. Responsible for prospective, concurrent, and retrospective utilization management review of inpatient, residential, partial, and intensive outpatient services to ensure medical necessity, appropriate length of stay, intensity of service and level of care. Evaluate and refer cases to the Medical Director for review of medical necessity, service levels, length of stay, etc. using approved clinical protocols. Processes referral and triage calls from members to assist them in finding the appropriate behavioral health services/providers when needed. Manage member crisis calls transferred internally or received directly to the Behavioral Health Department. This includes assessing the member and contacting community emergency resources to coordinate transport for face-to-face evaluation of the member’s needs. Perform other related duties as required. This position is full-time, fully remote (work from home) and requires some weekend, evening, or holiday coverage. Top 3 Required Skills/Experience – • Strong clinical and analytic skills • Ability to work independently and function as part of a team • Ability to quickly shift tasks based on clinical urgency Required Skills/Experience – The rest of the required skills/experience.
Include:
• Three (3) years of clinical experience treating mental health and substance abuse disorders required. • Proficiency with Microsoft Teams, Word, Outlook, and Excel. Preferred Skills/Experience – Optional but preferred skills/experience.
Include:
• One (1) year health insurance plan experience or managed care experience preferred. • Ability to troubleshoot basic computer connections and work in multiple programs Education/Certifications – Include: • Bachelor’s degree in Nursing, or an Associate’s degree in Nursing with a Bachelor’s degree in allied health or related field, or Master’s degree in Social Work, Psychology or Counseling required. • Current unrestricted State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required.

New York, New York, United States

Sprachkenntnisse

English

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