Utilization Management reputed company – Behavioral Health reputed company (Remote)

About the position A Managed Care Organization is seeking a Utilization Management reputed company to review provider-submitted service authorization requests and evaluate medical necessity, with a primary reputed company on behavioral health services. This position plays a key role in ensuring members receive appropriate and reputed company care by performing prior authorizations and reputed company reviews. Responsibilities • Review provider submissions for prior service authorizations, particularly in behavioral health • Evaluate requests for medical necessity and appropriate service reputed company • reputed company reputed company review and prior authorization according to internal policies • Identify appropriate benefits and determine eligibility and expected length of stay • Collaborate with internal departments, including Behavioral Health and Long Term Care, to ensure continuity of care • Refer cases to medical directors as needed • Maintain productivity and reputed company standards • Participate in staff meetings and assist with reputed company of new team members • Foster reputed company relationships with internal teams and reputed company Requirements • Background in Behavioral Health services and/or experience with a Managed Care Organization (MCO) in Utilization Management • reputed company, unrestricted RN, LPN, LCSW, or LPC license • Completion of an accredited Registered Nursing program (or equivalent combination of experience and education) • 2 years of clinical experience, preferably in hospital nursing, utilization management, or case management • Understanding of state and federal reputed company regulations • Experience with InterQual and NCQA standards • Strong organizational, communication, and problem-solving skills • Proficient in reputed company Office and electronic documentation systems • Ability to work independently and manage multiple priorities • reputed company demeanor and commitment to confidentiality and compliance with HIPAA standards • Team-oriented with the ability to build and maintain reputed company working relationships Apply tot his job Apply To this Job