Posted in General Business 13 days ago.
Type: Full-Time
This position gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria. Collects and analyzes utilization information. Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria. Performs independent reviews on children/adolescents who are in the care and custody of the State of Florida and residing in a therapeutic group home level of care.
Responsibilities
Masters level licensed behavioral health professional.
Good organization, time management and verbal and written communication skills.
Ability to function independently.
Knowledge of ICD and DSM IV coding or most current edition.
Ability to use computer systems.
Mental health counselor licensed under chapter 491 who has at least 2 years of experience in the diagnosis and treatment of serious emotional or behavioral disturbance in children and adolescents and who has no actual or perceived conflict of interest with any residential treatment center or program.
RN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or Doctoral Degree. If nurse, RNlicense at a minimum. If other than RN, Masters level licensed behavioral health professional.
Good organization, time management and verbal and written communication skills.
Knowledge of utilization management procedures, Medicaid benefits, community resources and providers.
Knowledge and experience in diverse patient care settings including inpatient care.
Ability to function independently and as a team member.
Knowledge of ICD and DSM IV coding or most current edition.
Ability to analyze specific utilization problems and creatively plan and implement solutions.
Ability to use computer systems.
2 or more years of experience post degree in a clinical, psychiatric and/or substance abuse health care setting.
Requires minimum of 2 years of experience conducting utilization management according to medical necessity criteria.
General Job Information
Title
Qualified Evaluator- Wyoming
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associate - Nursing, Master's - Behavioral Health
Education - Preferred
License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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