Utilization Mgmt SW
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Job Location:
Houston, MS - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
We are searching for a Utilization Management Social Worker. Someone who will provide prior authorization of outpatient and inpatient behavioral health services requiring authorization. This process includes using clinical judgement for utilization management application of product benefits understanding of regulatory requirements and verification of medical necessity utilizing evidence-based addition provider education is a component of this process.
Think you have what it takes
Qualifications:
- Masters Degree Social Work Licenses and Certifications Req Pref Enter Licenses/Certifications Licensing Authority
- LMSW - Licensed Master Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LCSW - Lic Clinical Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LMSW-AP - Lic Master Social Worker - Adv Pract Texas Behavioral Health (TBHEC) Experience Req
- 3 years Behavioral Health clinical experience required
- 2 years Managed Care Experience required
- 2 years Utilization Mgmt preferred
Responsibilities:
- Assess the treatment plan clinical information and medical necessity of all requested services
- Facilitates provider communication and education.
- Liaisons with internal and external managed care staff members.
- Assess and refers potential case management cases
- Ongoing assessment for quality indicators and concerns.
About Company
Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades suc ... View more
