Utilization Management Supervisor

We are currently hiring for the Maryland Behavioral Health Administrative Services Project! POSITION SUMMARY FULL-TIME position ranges from $42-$46 per hour depending on experience and is in Hanover, MD and also REMOTE. The Utilization Management Supervisor is responsible for serving as a resource for medical management programs, and related duties as assigned. This position is remote, but if needed, MUST be able to go into the Hanover, MD office. ESSENTIAL DUTIES AND RESPONSIBILITIES Serves as a resource for medical management programs. Identifies and recommends revisions to policies/procedures. Ensures staff adheres to accreditation guidelines. Ma assist with implementation of cost of care initiatives. May attend meetings to review UM and/or CM process and discusses facility issues. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Integrates the UM/CM functions to improve information flow and collaboration. Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services Ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost efficient, high quality care Manages consultation with facilities and providers to discuss plan benefits and alternative services Manages case consultation and education to customers and internal staff for efficient utilization of BH services Leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care; assists in developing clinical guidelines and medical policies used in performing medical necessity reviews Provides leadership in the development of new pilots and initiatives to improve care or lower cost of care. Participate in developing department goals, objectives, and systems Participate in staff meetings and attend other meetings and seminars as assigned. Recommend new approaches, policies, and procedures, to continually improve efficiency of the department and services performed. Efficiently performs duties as assigned and works as a team within division and company. Perform other related duties as assigned. REQUIRED SKILLS/ABILITIES Excellent verbal, written, and listening communication skills within the English language. Proven, high quality customer service (internal and external customers). Ability to work collaboratively. Solid ability to analyze situations carefully and adopt appropriate courses of action. Ability to understand and adhere to the duties, methods, and procedures required by the position. Excellent organizational skills and attention to detail. Ability to prioritize tasks. Ability to effectively communicate to large and small group audiences. Proficient with Microsoft Office Suite or related software. LICENSURE REQUIREMENTS FOR ALL FUNCTIONS Requires current, active, unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC, LMSW, LBA (as allowed by applicable state laws), LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States. For Government business only: LAPC, and LAMFT are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the manager's director has one of the types of licensure specified in the preceding sentence. Licensure is a requirement for this position. However, for states that do not require licensure a Board Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met; performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision. EDUCATION/EXPERIENCE REQUIREMENTS Prior experience in Managed Care setting preferred. MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and extensive experience in case management and telephonic coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders; or any combination of education and experience, which would provide an equivalent background. Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred. PHYSICAL REQUIREMENTS Possible prolonged periods of sitting at a desk and working on a computer. Standard hours of work Monday through Friday, 8:00 am – 5:00 pm. EMPLOYEE CHARACTERISTICS You strive to be the best in your field currently and in the future. You like to make your employer look good. You find solutions, where others only see problems. You are proactive, you make and meet commitments, and you perform your duties exceedingly well. You are aware of the employer’s needs at all times and are well-versed in what you personally and ATHENA can offer them as a whole. You have the ability to work with diverse, integrated, deliverable-driven teams to accomplish the larger mission. BENEFITS Support from a team of professionals committed to making your life better. 19 days of PTO. 12 paid holidays, 13 paid holidays during election years. Merit / COLA increases. Flex time allowed, during the same week. Medical, dental and vision insurance. Medical and dependent flexible spending account. Mass transportation benefit for the Maryland and Washington, D.C. area. 401k with a generous employer match. Easy to use employee self-serve HR portal. The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party. ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. #J-18808-Ljbffr