at Evolent Health in Springfield, Illinois, United States
Job Description
Your Future Evolves Here
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they’re supported to live their best lives, and when they feel welcome to bring their whole selves to work. That’s one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
What You’ll Be Doing:
Value Statement: To engage in collaborative, communicative, efficient, and effective behavioral health clinical review practices to help client’s members with mental health service authorization needs. Leaning into and advocation for the right care, at the right time.
Collaboration Opportunities: As a Behavioral Health Utilization Manager, you will be working with a diverse team of social works, counselors, nurses and psychiatrist to manage daily requests for behavioral services. Through strong organizational practices and attention to detail the Behavioral Health UM Team supports a range of managed care populations including Medicaid, Commercial and Exchange plans. This provided through all levels of care, inpatient, and outpatient. Working closely with multiple disciplines in the continuum of care, a range of opportunities is available to engage different clinical skills sets and experiences.
What You Will Be Doing:
+ Performs precertification and continue stays authorization requests for mental health and substance abuse diagnosis meeting established productivity guidelines.
+ Works in collaboration with the health care delivery team to maintain high quality and cost-effective service delivery.
+ Reviews for medical necessity and appropriateness of services using clinical review criteria.
+ Accurately documents all clinical information related to review determinations, contacts providers and members according to established timeframes and requirements.
+ Identifies and refers cases not meeting established clinical criteria to the Medical Director Review.
+ Identifies and escalates quality of care issues to the Leadership.
+ Identifies potential cases for Care Management and engages in clinical staffings.
Qualifications Required and Preferred:
+ License to practice Behavioral Health services independently, and/or have obtained the state required licensure as outlined by the applicable state. This includes but is not limited to licenses such as LPC, LCSW, LMFT, LMHC, LIMHP, and RN, Required.
+ Master’s degree in Social Work, Counseling or RN, Required.
+ Minimum of three years of direct clinical patient care to include inpatient or residential care, Preferred.
+ Minimum of one year of experience with medical management activities in a managed care environment, Preferred.
+ Knowledge of managed care principles, MCO and Risk Contracting arrangements, Preferred.
+ Knowledge of health care resources and continuum of care, Preferred.
+ Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual, ASAM), Preferred.
+ Possess basic computer skills, strong typing skills and proficiency in Microsoft Office, Required.
+ Comfort multitasking and operating in multiple systems simultaneously, Preferred.
+ We are looking for team members who possess enthusiasm, a strong work ethic, integrity, Required.
Technical Requirements:
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.
The expected base salary/wage range for this position is $75,000-80,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
