*Job Title:* REMOTE Behavioral Health Utilization Review
*Facility's Location*: Corvallis, OR 97330 but your will be working REMOTELY
*Duration: *13 weeks
*Shift: *Days (0800-1700) occasional weekends, contract ending 4/30/24
*Job ID*: 265559
*JOB SUMMARY/PURPOSE*
* Reviews, assesses, and evaluates clinical information used to support Utilization Management (UM) decisions based on established clinical criteria and applies intermediate knowledge of coding and medical record research.
Facilitates professional communication to ensure the authorization process is completed in a patient centered manner with adherence to quality and timeline standards.
Applies knowledge of applicable Medicare (CMS), Medicaid (OHA), and other plan specific rules and regulations to the authorization process.
Reviews cases that have a low to moderate level of service intensity.
*DEPARTMENT DESCRIPTION*
* This facility operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc.
(IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; This facility offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; This facility is also the third-party administrator for this facility’s self-funded employee health benefit plan.
As part of an Integrated Delivery System, facility is strategically and operationally aligned with the facility’s mission of Building Healthier Communities Together.
*EXPERIENCE/EDUCATION/QUALIFICATIONS*
* Master's degree in Mental Health, Social Work, Clinical Psychology or a closely related field required.
*Current unencumbered Oregon credential/licensure* in one (1) of the following required:
* Licensed Clinical Social Worker (LCSW).
* Licensed Professional Counselor (LPC).
* Licensed Psychologist (PhD or PsyD).
* Clinical Social Work Associate (CSWA).
* Licensed Master of Social Work (LMSW).
* Licensed Marriage and Family Therapist (LMFT).
* One (1) year clinical experience required.
* Experience or training in the following required:
* Health care delivery systems and/or managed care patients.
* Computer applications including electronic documentation (e.
g.
, MS Office, EPIC, Clinical Care Advanced).
* Experience in the following preferred:
* Utilization management.
* Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
_*Should you be interested, let's discuss this briefly at your earliest convenience and please feel free to contact me at 703-652-7170, my name is Ailyn, I am available from Mon to Fri at 9a-6p EST.
*_
*Who We Are?*
Since 2001 InfiCare has been providing contract and direct hire staffing services to its clients across the US.
Click below links to review some of the best workplace awards won by InfiCare:
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Job Types: Full-time, Contract
Pay: $59.
00 - $61.
00 per hour
Expected hours: 40 per week
Benefits:
* 401(k)
* Health insurance
Schedule:
* 8 hour shift
* Day shift
* Weekends as needed
Experience:
* Health care delivery systems and/or managed care patients.
: 1 year (Required)
* Epic: 1 year (Required)
* Medicare and Medicaid rules in Oregon: 1 year (Preferred)
* regulations, health plan benefit structure and policy in OR: 1 year (Preferred)
* clinical: 1 year (Required)
* Utilization management: 1 year (Preferred)
License/Certification:
* Licensed Professional Counselor (LPC) (Preferred)
* Clinical Social Work Associate (CSWA) (Preferred)
* Licensed Master of Social Work (LMSW) (Preferred)
* Licensed Marriage and Family Therapist (LMFT) (Preferred)
* Licensed Clinical Social Worker (LCSW) (Preferred)
Work Location: In person
Whatsapp
