Job Details

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 o...Clinical, Behavioral Health, Management, Consultant, Registered Nurse, Clinic, Retail