Healthcare

Healthcare-Utilization Management Review & Appeals

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

Strategic Staffing Solutions (S3) is currently looking for a Healthcare-Utilization Management Review & Appeals for a contract opening with one of our largest clients working in Detroit!

This is a Contract Opportunity with our company that MUST be worked on a W2 ONLY, NO C2C eligibility for this position.  The details are below.

Healthcare-Utilization Management Review & Appeals

Job Summary

  • Responsible for providing telephonic and e-Referral case review and authorization of services utilizing established mental health and substance abuse medical necessity criteria to provide quality care appropriate to clinical needs.
  • Responsible for prospective, concurrent, and retrospective utilization management review of inpatient, residential, partial, and intensive outpatient services to ensure medical necessity, appropriate length of stay, intensity of service and level of care.
  • Evaluate and refer cases to the Medical Director for review of medical necessity, service levels, length of stay, etc. using approved clinical protocols.
  • Processes referral and triage calls from members to assist them in finding the appropriate behavioral health services/providers when needed.
  • Manage member crisis calls transferred internally or received directly to the Behavioral Health Department.
  • This includes assessing the member and contacting community emergency resources to coordinate transport for face-to-face evaluation of the member’s needs.
  • Perform other related duties as required.

Qualifications

  • Strong clinical and analytic skills
  • Ability to work independently and function as part of a team
  • Ability to quickly shift tasks based on clinical urgency
  • The rest of the required skills/experience.
  • Three (3) years of clinical experience treating mental health and substance abuse disorders required.
  • Proficiency with Microsoft Teams, Word, Outlook, and Excel.

Preferred skills/experience. Include:

  • One (1) year health insurance plan experience or managed care experience preferred.
  • Ability to troubleshoot basic computer connections and work in multiple programs

Education/Certifications – Include:

  • Bachelor’s degree in Nursing, or an Associate’s degree in Nursing with a Bachelor’s degree in allied health or related field, or Master’s degree in Social Work, Psychology or Counseling required.
  • Current unrestricted State of Michigan clinical license (RN, LMSW, LLP, LP, or LPC) required.

How to Apply:  send resume and contact information to Genecee Lopez, Sourcing Specialist, at GLopez@strategicstaff.com

 The S3 Difference:

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities. The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement 

Job ID: JOB-207343
Publish Date: 22 Sep 2022

Tagged as: Healthcare-Utilization Management Review & Appeals