Posted in General Business 30+ days ago.
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Location: Buffalo, New York
The Specialist Behavioral Health Utilization Management assists in ensuring that quality, cost-effective care is delivered to members of all product lines of HealthNow NY Inc. Assists in containing the cost of health care services by detecting, resolving, and preventing improper utilization of member benefits by applying utilization processes such as prior authorization for inpatient/ outpatient services/ appeals / claims/ inquiry review under the supervision of the Manager or Supervisors of that department. Maintains adherence to established Policy and Procedures, Quality Improvement processes, and Compliance Standards.
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Knowledge and Skills
Excellent time management skills with the ability to multitask and be flexible based on department needs Public communication and presentation skills Computer applications; including but not limited to: Microsoft Office applications Excellent organizational skills and attention to detail Excellent verbal and written communication skills Strategic thinking/planning skills and ability to work effectively with minor supervision Polished, professional image and reputation. Demonstrated personal accountability. Must be able to work in a fast-paced team environment with daily work processing under highly regulated deadlines High degree of business maturity and demonstrated confidentiality High energy level and ability to project enthusiasm Persuasive communication style Preferred experience in utilization management, managed care, health insurance industry, including an understanding of Behavioral Health provider specialties , Behavioral Health service delivery systems, and Behavioral Health levels of care NOTE: Valid drivers license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate's driving record) if applicable to the job responsibilities, i.e., on-site
External Contacts: Utilization Management (UM) tasks and actions require interaction with provider offices, facilities, vendors, members, and external regulatory agencies.
Registered Nurse OR Licensed Clinical Social Worker (LCSW) ORLicensed Mental Health Counselor (LMHC)
BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York's leading health care companies that provides access to quality health care and solutions for members throughout Upstate New York. Since 1936, BlueCross BlueShield has helped millions of people gain access to health care. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association. As the region's leading health plan, serving over 800,000 members, BlueCross BlueShield believes in taking small steps towards healthier living. You can visit our website at www.bcbswny.com.
BlueCross BlueShield of WNY
Full Time Regular
Or Masters degree Behavioral Health Specialist. 1-3 years Clinical and Managed Healthcare experience required. 3-5 years Behavioral Health and/or Substance Abuse experience required. NYS LMSW, LCSW, LMHC, or RN. CASAC or RN with Behavioral Health experience. CCM (Certified Case Manager) preferred.
Irregular hours Must be able to accommodate alternate shifts/days Must be able to work in an office environment Must be able to occasionally attend off-site meetings, events, conferences Must have ability and access to work from remote location such as home Must be able to accommodate local travel. Valid drivers license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate's driving record) Repetitive Motion Reaching Prolonged Sitting Walking Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) Vision Req: Close vision (clear vision at 20 inches or less) Vision Req: Distance (clear vision at 20 feet or more) Weight: lift/carry/push/pull under 10 lbs.
Required Education:Bachelors Degree (Nursing)
Position Posting Location