Centene Corporation Utilization Management Reviewer in Lenexa, Kansas
ProfessionalPosition Purpose: Authorize and review utilization of physical and behavioral health services provided in inpatient facilities, skilled nursing facilities, outpatient, and out-of-network settings. Assure appropriate levels of care and medical necessity in a manner that supports the recovery process.
Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity.
Monitor quality of care and collect and analyze utilization data
Serve as a resource and liaison between the health plan, behavioral providers, facilities, member and families
Provide and review member intakes and initial evaluations
Comply with performance measures in regards to denials, higher level of care admission certifications and concurrent review timeliness
Develop and maintain collaborative relationships with providers and educate on levels of care
Interact with physicians, social workers, providers, case managers, and internal staff to develop discharge plans and oversee their implementation
Authorize and/or review utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Assure appropriate levels of care and medical necessity in a manner that supports the recovery process
Education/Experience: Graduate of accredited school of Nursing. 3+ years of utilization management or clinical supervision experience in a physical health setting. Previous experience documenting in Case Management or Utilization Management systems.
Licenses/Certifications: 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.
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.
TITLE: Utilization Management Reviewer
LOCATION: Lenexa, Kansas
COMPANY: Clinical & Nursing
POSITION TYPE: Professional