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Job Summary

This position is responsible for managing the development, implementation and administration of daily Behavioral Health Utilization Management Services operations including preauthorization, prospective, concurrent, and retrospective review. Establish communications, protocols and procedures for utilization management activities ensuring quality health care delivery by an ongoing interface with HCSC counterparts. Meet and exceed internal and external customer service expectations.

JOB REQUIREMENTS:

• Masters level Behavioral Health Professional (LPC, LCPC, LCSW, LMFT, RPsy) with license to practice at the independent practice level OR Registered Nurse (RN) with Bachelor's Degree and psychiatric nursing experience including 5 years of post-Masters clinical experience or combination of education and experience. Professional license is current, active, and in good standing in State of TX.
• 2 years supervisory or management (with Direct Reports) experience in a behavioral health utilization management or medical utilization management organization with comprehensive knowledge of behavioral health practices and terminology OR 3 years supervisory or management (with Direct Report) experience in a BH clinic, facility, or group with oversight of utilization metrics and authorization process.
• 7 years clinical experience in psychiatric setting or own behavioral health practice.
• Utilization management knowledge.
• PC experience to include Microsoft Word, Excel, PowerPoint.
• Analytical skills and experience presenting recommendations to executive management, medical staff and/or clients.
• Interpersonal and problem-solving skills.
• Presentation skills and ability to present information clearly, concisely, and in a positive manner to internal and external customers.
• Knowledge of UM Metrics, HEDIS, NCQA and URAC.

PREFERRED JOB REQUIREMENTS:

• Advanced degree
• 3 years management experience as 2nd level of management.
• Exposure to Managed Care - Utilization Management, Utilization Review, Case Management,

*Exposure to Managed Care - Utilization Management, Utilization Review, Case Management, etc - needed for this role*

*Must have Presentation skills and the ability to present information clearly, concisely to internal and external customers*

** Masters-level Behavioral Health Professionals: Please note that you MUST be licensed to practice at the independent level for this role. The # of years of clinical experience required for this role is post licensure (# of years) at the independent level**

#LI-FW1

#LI-Hybrid
This is a Hybrid/Flex role for Richardson, Texas HQ

Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range
$82,700.00 - $149,300.00