Community Health Choice

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Behavioral Health Utilization Manager

at Community Health Choice

Posted: 1/14/2020
Job Status: Full Time
Job Reference #: 148559
Keywords:

Job Description

About Us

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Profile

Behavioral Health Utilization Manager will assist the Behavioral Health Program Manager and the Medical Director in the review of medical records submitted for appeals by providers due to an adverse determination. Utilizes nationally recognized evidenced based clinical criteria, approved medical guidelines, and company policies. Apply 3M Coding and reimbursement guidelines for DRG assignment. Provides written response of the outcome of the appeal to the provider. Assists in the ongoing development and maintenance of a database for tracking, trending and reporting appeals cases.

QUALIFICATIONS:

  • Masters Degree
  • LCSW, LMFT, or LPC unrestricted Texas license
  • Two years experience in an acute psychiatric care setting.
  • Two years experience in utilization and appeal review in a managed care environment with Medicaid and Medicare members.

OTHER SKILLS:

  • Above Average Verbal communication skills (Heavy Public Contact)
  • Writing /Composing (Correspondence /Reports)
  • Analytical
  • Terminology
  • Research
  • MS Word
  • MS Excel
  • Able to work independently under general instructions and working within a team environment
  • Able to apply the appeal and medical necessity criteria and use critical thinking
Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Job Category

CHC Clinical

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!