Behavioral Health Utilization Management Coordinator
Location: Dublin, OH, United States
Date Posted: Sep 8, 2023
Welcome Bonus: $2,500 for external candidates
Location: This position is located at our Dublin, OH campus.
Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health.
We’re on a mission to make healthcare simpler and more effective. We fight to ensure our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams, so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.
The Behavioral Health Care Coordinator - Utilization Review provides utilization management for all behavioral health/substance abuse levels of care as indicated per the Health Benefit Plan. Care coordination services are facilitated post discharge to ensure that members have a safe and effective transition to the next level of care.
What you’ll do
- Provide daily utilization review on all inpatient mental health/substance use members.
- Provide utilization review on all proposed treatments for outpatient services as directed by the Health Benefit Plan.
- Negotiate for services needed if no clear benefit exists or if the services can only be provided out of network.
- Act as a behavioral health resource for all internal work groups.
- Provide aftercare follow up outreach to targeted population per designated behavioral health care coordinator.
- Maintain a working knowledge of all workflows related to utilization management.
- Maintain a working knowledge of all benefit plans and know where to access the needed information.
- Maintain contact with internal clinical staff for transfer of cases for medical management when appropriate.
- Maintain open communication with Manager or designee.
- All other duties as assigned.
What you’ll bring
- Licensure: Active license in good standing as a Registered Nurse (RN) or Licensed Social Worker (LSW) in the State of Ohio required.
- Education: undergraduate degree in a related field preferred
- Minimum of 4 years’ experience in a Behavioral Health setting
- Ability to make decisions that are timely and well thought out that achieve results consistent with business goals and organizational culture
- Possess excellent interpersonal communication skills
- Excellent critical thinking skills
- Ability to work independently with minimal supervision
- Possess excellent computer skills including Microsoft applications
- Possess excellent time management skills
- Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies
- Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
- Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
What’s in it for you
- Compensation: Competitive base pay, incentive plans and employee referral bonuses.
- Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
- Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
- Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
- Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
- Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
- Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!
What you should know
- Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
- Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check
- Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer.
- Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
- Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.
- Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.
- Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment.
If you believe you’ve encountered a recruiting scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov and your state’s Attorney General at https://www.usa.gov/state-attorney-general.