Behavioral Health - Utilization Management Clinical Consultant - KY

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Position Summary

This is a fully remote Utilization Review Clinical Consultant with a schedule of Tuesday-Saturday.

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.  
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate. 
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. 
• Provides triage and crisis support. 
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• Coordinates with providers and other parties to facilitate optimal care/treatment. 
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. 
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. 
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. 
•  Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.  

Required Qualifications

• Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license or a compact license that covers Kentucky with psychiatric specialty, or behavioral health experience or certification 
• 3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, alternative care setting, or ambulatory care experience 
• Willing and able to work Tuesday-Saturday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs 

Preferred Qualifications

• Managed care/utilization review experience 
• Ability to multitask, …