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Position Summary

This is a fulltime remote Utilization Management Clinical Consultant opportunity for candidates residing in Florida. Schedul e is Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs.

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis support.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization .
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

• Must reside in Florida
• Licensed Independent Behavioral Health clinician or an unrestricted Registered Nurse (RN) license in FL with psychiatric specialty or behavioral health experience
• 3+ years clinical practice experience in behavioral health e.g., psychiatric hospital , residential or behavioral health treatment setting
• 1+ years' experience using MS office applications such as Teams, Outlook, Excel, and Word; proficiency with computer skills which includes navigating multiple systems and keyboarding.
• 1+ year electronic medical record documentation experience
• Schedule is Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs , including occasional rotating weekend and holiday schedules

• Outpatient behavioral health experience highly preferred
• Managed care/utilization review experience
• Experience in a behavioral health inpatient and outpatient setting
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

• Masters Level Education resulting in an Independent Behavioral Health Clinical License OR Minimum of a Diploma RN or Associate's degree in Nursing