Behavioral Health Utilization Manager, RN

The Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned patients. Applies approved criteria for justification of admission and continued stay in the appropriate level of care. Notifies the Medical Director regarding the review of medical records submitted by providers for peer-to-peer reviews. Utilizes nationally recognized evidence-based clinical criteria, approved medical guidelines, and company policies. Provides timely responses to the outcome for the provider based on State policy. Assists in the ongoing development and maintenance of a database for tracking, trending, and reporting cases. Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs. Community is an Equal Opportunity Employer. Qualifications Bachelor’s degree in nursing. Current Texas state Registered Nurse License. Two (2) years of experience in an acute psychiatric care setting. Two (2) years of experience in utilization and appeal review in a managed care environment with Medicaid and Medicare members. Computer literate with knowledge of MS Word, MS Excel, Outlook, and telephone systems. #J-18808-Ljbffr Case Management Society of America (CMSA) ®