Job Description:
This position is a hybrid role that combines the roles and expertise of Utilization Review and Care management. This role is essential in ensuring that members receive high-quality, cost-effective care. Overall, utilization management is an essential process that not only ensures the medical necessity of care but also assists in monitoring and controlling healthcare costs while prioritizing member safety. These processes involve detailed assessments, evidence-based guidelines, and coordination among various healthcare professionals to achieve optimal outcomes for members. The ideal candidate will possess a strong understanding of utilization management principles, as well as a solid foundation in healthcare operations and regulatory compliance.
Candidates will apply expertise to review medical records and treatment plans for individuals with specific conditions or diagnosis including medical and behavioral health conditions to ensure that services are medically necessary, appropriate, and cost-effective.
Job Specifics
Pay Range LCSW: $38.77 - $59.82 Exempt
Benefits Eligible: Yes
FTE: Full time
Shift: Hybrid Role. Monday - Friday, 8:00am - 4:30pm. (Schedule finalized on hire) Occasional weekends and Holidays.
REQUIRED LCSW LICENSURE
Essential Functions
Utilization Review and Care Management of members with specific treatment plans, conditions, or diagnosis including medical and behavioral health conditions
Provide ongoing training and support to families and caregivers.
Collect, analyze, and interpret data to evaluate the effectiveness of interventions.
Stay current with the latest research and best practices in assigned population.
Inform Select Health Medical and Behavioral Health policy and procedure.
Peer to Peer and Peer review to evaluate and influence the work of others in the field to ensure adherence to ethical standards, best practices, and regulatory requirements.
Occasional travel to provider locations within Select Health region.
Review medical records to determine the medical necessity of services.
Evaluate the appropriateness of procedures, diagnostic assessments, functional behavior assessments, and treatment plans.
Make timely and informed determinations about the medical necessity and appropriateness of services.
Adhere to regulatory requirements, payer guidelines, and ethical standards.
Facilitate Communication, Organize Collaborative Meetings, and Resolve Conflicts with healthcare providers to ensure coordinated member care.
Communicate with members, families, and insurance representatives.
Conduct comprehensive assessments of members' needs.
Develop and implement individualized care plans.
Educate and empower members and families.
Advocate for members' rights and access to care.
Monitor and evaluate the effectiveness of care plans.
Minimum Qualifications
Preferred Qualifications
Physical Requirements
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$38.77 - $59.82
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits package here.
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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All positions subject to close without notice.