Manager, Utilization Management

Job Description:

Position Purpose: Perform duties to conduct and manage the day-to-day operations of the utilization management function. Communicate with staff to facilitate daily department functions.

 

Knowledge/Experience: LCSW, LMFT, LPC, PhD, PsyD or RN licensed in Arizona, with experience in psychiatric and/or substance abuse health care settings including utilization review. Knowledge of utilization review procedures, and familiarity with mental health and substance abuse community resources and RBHA network providers preferred. Compatibility with recovery philosophy of treatment. 3 ? 5 years utilization management experience. Familiarity with Medicaid managed care practices and policies

 

Competencies: Manager: Integrity, Flexibility, Communication, Critical Thinking, Building a Successful Team, Decision Making, Planning and Organizing, Building Strategic Working Relationships, Technical and Professional Knowledge

 

Position Responsibilities: ? Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. ? Promote compliance with federal and state regulations and contractual agreements. ? Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions. ? Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure. ? Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management. ? Facilitate on-going communication between utilization management staff and contracted providers. ? Develop staff skills and competencies through training and experience.

 

License/Certificates: LCSW, LMFT, LPC, PhD, PsyD or RN licensed in Arizona required. AZ Independent Behavioral Health License required.