Description
Behavioral Health Utilization Manager, RN
Houston, TX - Remote
Built to Care. Driven to Improve. At Community Health Choice, we’re a nonprofit health plan dedicated to improving the health and well-being of Texans, especially underserved communities. Our employees bring purpose into practice every day through compassion, collaboration, and a commitment to better outcomes.
The Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned patients. Applies approved criteria for justification of admission and continued stay in the appropriate level of care. Notifies the Medical Director regarding the review of medical records submitted by providers for peer-to-peer reviews. Utilizes nationally recognized evidence-based clinical criteria, approved medical guidelines, and company policies. Provides timely responses to the outcome for the provider based on State policy. Assists in the ongoing development and maintenance of a database for tracking, trending, and reporting cases.
Qualifications include:
- Bachelor’s degree in nursing.
- Current Texas state Registered Nurse License.
- Two (2) years of experience in an acute psychiatric care setting.
- Two (2) years of experience in utilization and appeal review in a managed care environment with Medicaid and Medicare members.
- Computer literate with knowledge of MS Word, MS Excel, Outlook, and telephone systems
Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs.
Community is an Equal Opportunity Employer.
Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement.
To learn more, contact:
Brittni Johnson, Talent Attraction Partner I
[email protected]