Utilization Mgmt SW chez TCH Medical Center

We are searching for a Utilization Management Social Worker.  Someone who will provide prior authorization of outpatient and inpatient behavioral health services requiring authorization. This process includes using clinical judgement for utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing evidence-based criteria. In addition, provider education is a component of this process.

Think you have what it takes?

Qualifications:

• Master's Degree Social Work Licenses and Certifications Req Pref Enter Licenses/Certifications Licensing Authority 
• LMSW - Licensed Master Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LCSW - Lic Clinical Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LMSW-AP - Lic Master Social Worker - Adv Pract Texas Behavioral Health (TBHEC) Experience Req 
• 3 years Behavioral Health clinical experience required
• 2 years Managed Care Experience required
• 2 years Utilization Mgmt preferred

Responsibilities:

• Assess the treatment plan, clinical information, and medical necessity of all requested services
• Facilitates provider communication and education.
• Liaisons with internal and external managed care staff members.
• Assess and refers potential case management cases
• Ongoing assessment for quality indicators and concerns.

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