Utilization Manager, Lmhc

Responsible for carrying at patient care review program which facilitates the appropriate use of resources and quality of care.

JOB RESPONSIBILITIES AND STANDARDS OF PERFORMANCE:

Responsibility and Standards

1.Develop collaborative relationships with MCO's including participating in third party on-site visits and appeals.

Weight: 20%

Responsibility and Standards:

2.Participates in daily clinical rounds, or otherwise reviews cases with clinicians.

Weight: 15%

Responsibility and Standards:

3.Consult to administrative/clinical staff regarding utilization management related

issues.

Weight: 15%

Responsibility and Standards:

4.Performs telephone reviews.

Weight: 20%

Responsibility and Standards

5.Makes appropriate EPIC entries and assists Patient's Financial Services Department when indicated.

Weight: 15%

Responsibility and Standards

6.Negotiates and processes single case agreements as needed.

Weight: 5%

Responsibility and Standards

7.Participates on McLean committees and assists in CQI efforts as needed.

Weights 5%:

Responsibility and Standards

8.Assists in developing and refining department policies and practices.

Weight: 5%

Performs other duties as assigned by the Program Director

Education/Licensure:

Massachusetts licensure in an appropriate discipline (e.g. R.N., LCSW, LMHC etc.)

Skills:

Good clinical skills. Interpersonal, communication and organizational skills plus ability to make judgments are essential.

Experience:

Two years of current or recent clinical experience..