Remote Optum Clinical Review Jobs in Decatur, GA

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Education Level: Master's

This is a TEMP-TO-PERM Care Manager RN position. The position is created to meet and exceed the service level requirements to their customers.

These positions require a Master's Degree and a LCSW or LCPC license.

Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience. She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.

Description:

Under general supervision, and in collaboration with other members of the clinical team, reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects. Monitors level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation.- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.- Participates in quality improvement activities, including data collection, tracking, and analysis Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.

Requirements/Certifications:

Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.

Knowledge and experience in inpatient setting.

Knowledge of DSM V or most current diagnostic edition. Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.

Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience.

She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.

The manager will give preference to candidates located in the Alpharetta, GA area; however, she is open to remote candidates as well.

The Alpharetta, GA candidate will also have the ability to work remote.

This is an inbound telephonic position and the selected candidate will manager about 25 calls/day.

The majority of the calls are from providers and the other calls are from members and their family members.

The selected candidate will have 1-2 years of Managed Care/Clinical Review experience and 3-5 clinical experience.

There are 55 people on this team and it is divided into 3 clusters.

The training will be web based and it will be about 2-3 weeks long. The hours will be from 8am - 5pm.

The selected candidate MUST be comfortable with navigating through multiple systems and comfortable with Outlook, Instant Messenger and Email. The manager will conduct telephone intervie

LCSW or LCPC license 

Riya Khem

Life Science Recruiter 

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I

DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549