Utilization Manager (Cenpatico) occupation at Centene Corporation in Austin

Centene Corporation is employing Utilization Manager (Cenpatico) on Sun, 19 Aug 2012 08:01:38 GMT. Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange...

Utilization Manager (Cenpatico)

Location: Austin Texas

Description: Centene Corporation is employing Utilization Manager (Cenpatico) right now, this occupation will be placed in Texas. Detailed specification about this occupation opportunity kindly read the description below. Position Purpose:
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects.

Knowledge/Experience:
Master’s degree in Behavioral Health or Registered Nurse required. Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN with minimum of 3 years experience in psychiatric and/or substance abuse health care settings including utilization review. Knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.

Position Responsibilities:

• Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
• Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
• Interact with physicians and social workers for discharge planning.
• Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
• Compile and report daily review activity and facility statistics.
• Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
• Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
• Track benefit usage and advise appropriate parties of exhaustion of benefits.
• Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.

License/Certificates: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Centene Corporation.

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This occupation starts available on: Sun, 19 Aug 2012 08:01:38 GMT

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