Utilization Management Licensed Behavioral Health Specialist

Utilization Management Licensed Behavioral Health

Help Montanans live healthier lives with a rewarding career as a Utilization Management Nurse/Professional. Blue Cross and Blue Shield of Montana has some exciting opportunities in our Helena location for individuals who are high energy, self-motivated professionals who are looking for a position where you can optimally apply your skills and knowledge to improve our covered members’ lives and be a part of a dynamic team and organization.

As a Utilization Management Professional for behavioral health you will validate inpatient admissions according to nationally recognized standards (Milliman, ASAM) and assess inpatient events for compliance with the Utilization Review Plan filed with the State of Montana and URAC standards. You will also be responsible to take the appropriate action to comply with third party requirements, meet or exceed required time frames and strive to demonstrate medical savings through reviewing services for medical necessity, over-utilization, intensity and appropriateness.  

The Utilization Management Professional at Blue Cross and Blue Shield of Montana will have the following attributes and abilities:

• Excellent interpersonal skills, phone manners, organizational skills
• Ability to plan and accomplish goals using a certain degree of creativity, latitude and flexibility with scheduling.
• Ability to establish priorities and work independently
• Monitor the care plan to determine service effectiveness and appropriateness to determine that services being delivered meet the client’s needs.
• Establishes and maintains collaborative relationships with internal and external customers
• Maintains accurate records and confidentiality.
• Focuses on patients who are medically complex and require additional medical and psychosocial support.
• Promotes customer services/case satisfaction to achieve established goals/objectives.

Our ideal candidate will possess:

• Must be a Licensed Clinical Social Work (LCSW), or a Licensed Clinical Professional Counselor (LCPC) or a Licensed Registered Nurse.
• One year of utilization management, quality improvement, or discharge planning
• Two years of recent health care experience
• Knowledge of  health care principles, procedures, methods and techniques in behavioral health
• Knowledge of modern practices and principles of medical disease processes
• A working knowledge of resources internal and external to the health plan including community resources
• A solid understanding of managed care and health care benefits/managed care/third party reimbursement
• Knowledge of federal and state statutory requirements
• Proficient in Microsoft Office suite with such programs as Word and Excel as well as experience with internet searches  

In return you will receive an excellent starting salary, an exceptional benefits package including medical, dental, vision, and prescription coverage, 401k with company match, retirement plan, vacation and personal time, tuition reimbursement, wellness program, and paid time off for community service activities.

If you would like to be a part of Blue Cross and Blue Shield of Montana and its commitment to Montana, please complete your application at www.bluecrossmontana.com or contact your local job service for immediate consideration. This position will remain open until November 16, 2009. 

For consideration please apply via our website at: https://www.bcbsmt.com/Pages/globalhome.aspx

We are an Equal Opportunity Employer

Our ideal candidate will possess:

• Must be a Licensed Clinical Social Work (LCSW), or a Licensed Clinical Professional Counselor (LCPC) or a Licensed Registered Nurse.
• One year of utilization management, quality improvement, or discharge planning
• Two years of recent health care experience
• Knowledge of  health care principles, procedures, methods and techniques in behavioral health
• Knowledge of modern practices and principles of medical disease processes
• A working knowledge of resources internal and external to the health plan including community resources
• A solid understanding of managed care and health care benefits/managed care/third party reimbursement
• Knowledge of federal and state statutory requirements
• Proficient in Microsoft Office suite with such programs as Word and Excel as well as experience with internet searches