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The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
work at home – must be licensed in the state of Kentucky
The Utilization Management Behavioral Health Professional 2 completes telephonic and paper reviews to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.
Complete telephonic and/or paper reviews with behavioral health facilities and behavioral health providers
Reviews discharge plans
Coordinates with Care Coordination and Case Management
Prepares cases for clinical rounds with Medical Directors
Degree in Nursing or a Master's degree in a Behavioral Health related field such as Social Work, Counseling, and/or Psychology, from an accredited university.
Must be licensed in the state of Kentucky
Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or Licensed Marriage & Family Therapist (LMFT) or other professional licenses
Minimum of three (3) years of post-degree clinical experience in direct patient care
Three (3) years or more of Behavioral Health experience
Proficiency with Microsoft Office products
Experience working with computers
Minimum of two (2) years of utilization management experience
Experience with utilization review process
Knowledge of community health and social service agencies and additional community resources in the state of KY
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
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Scheduled Weekly Hours
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