[Hiring] Behavioral Health Utilization Manager @Banner Health

Role Description

As a Behavioral Health Utilization Care Manager, you will:

• Review prior authorization requests for outpatient behavioral health services, ensuring medical necessity and alignment with clinical guidelines and health plan requirements.
• Collaborate with providers and interdisciplinary teams to support timely care decisions.
• Participate in team initiatives as prior authorization programs continue to expand.
• Monitor care to ensure treatment is appropriate and effective.
• Assess the member’s plan of care and develop, implement, monitor, and document the utilization of resources and progress of the member through their care.
• Engage internal and external resources to ensure members receive appropriate care plan and discharge planning services.
• Monitor for quality of care concerns and staff regularly with medical directors.
• Provide education and recommend alternative care plans for treatment not meeting medical necessity criteria.
• Conduct prior authorization, concurrent, retrospective, and appeal reviews.

Qualifications

• Master’s degree in social work, counseling, or related field with independent or associate licensure.
• Licensure in at least one of the following categories as required by state law: Social work, professional counseling, or marriage and family.
• Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.
• Three years of clinical experience (i.e., counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
• Working knowledge of care management, case management, hospital, and community resources.
• Demonstrated critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
• Ability to work effectively independently and in an interdisciplinary team format.

Requirements

• Experience with behavioral health utilization management (preferred).
• Additional related education and/or experience (preferred).

Benefits

• Pay range: $28.28 - $47.13 / hour.
• Commitment to pay equity and transparency.
• Actual pay determined at offer based on years of relevant work experience, education, certifications, skills, and geographic location.

Company Description

Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans, known nationally as an innovative leader. BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs.