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Utilization Management Lcsw information

What is the difference between Utilization Management Lcsw vs Medical Social Worker?

AspectUtilization Management LcswMedical Social Worker
CredentialsLCSW, often with additional certifications in utilization reviewLCSW, sometimes with clinical or medical social work certifications
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, patient homes, healthcare settings
Employer & IndustryInsurance providers, healthcare management firmsHospitals, medical facilities, outpatient clinics
Primary FocusReviewing medical necessity, authorizing services, ensuring appropriate careProviding psychosocial support, care planning, patient advocacy

The Utilization Management Lcsw primarily focuses on reviewing medical necessity and authorizing healthcare services within insurance and healthcare organizations. In contrast, a Medical Social Worker provides direct psychosocial support and patient advocacy in clinical settings. While both roles require an LCSW credential, their work environments and primary responsibilities differ significantly.

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Utilization Management Lcsw jobs near you
Infographic showing various Utilization Management Lcsw job openings in Missouri as of September 2026, with employment types broken down into 15% As Needed, 77% Full Time, and 8% Part Time. Highlights an 85% In-person, and 15% Remote job distribution.

Utilization Management Professional

Saviance

Saint Louis, MO • On-site

Other

Re-posted 18 days ago

Job description

Job Title

Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria. Proposes alternatives when the requested services do not meet medical necessity criteria or are outside the contracted network. As assigned and based on credentials, monitors and reviews specialized requests and treatment records such as Treatment Record Forms. Provides information to enrollees, providers, and internal staff regarding covered and non-covered benefits, community resources, agency programs and policies, procedures and criteria. Develops and manages new enrollee transitions and those involving a change in provider relationships. Develops and implements transition plans, as indicated, to ensure continuity of care. Negotiates and documents single case agreements according to procedures. In conjunction with providers and facilities, identifies, develops and monitors discharge plans. Collaborates with the Care Coordination team to implement support for transitions in care. Facilitates timely sharing of enrollees' clinical information (such as previous treatment, medications, and planned care) in order to promote continuity of care. Interacts with Medical Directors and Physician Advisors to provide case information and discuss clinical and authorization questions and concerns regarding specific cases. Assures that case documentation for each decision is complete, including related correspondence. Participates in Care Coordination team and utilization management activities, including collaboration with other staff on enrollee cases, and performing data collection, tracking, and analysis.

Maintains an active work load in accordance with performance standards. Works with community agencies as appropriate.

Participates in network development including identification and recruitment of quality providers as needed. Advocates for the enrollee to ensure health care needs are met. Interacts with providers in a professional, respectful manner.

Provides coverage of Nurse Line and/or Crisis Line as requested or required for position.

Associates - Nursing Bachelors - Nursing Bachelors - Social Work Social Work Masters - Social Work LPN LCSW - Licensed Clinical Social Worker LMHP - Licensed Mental Health Professional LPC - Licensed Professional Counselor LMFT - Licensed Marital and Family Therapist LISAC - Licensed Independent Substance Abuse Counselor certification. RN or clinical credentials in a behavioral health field.

If nurse, RN license at a minimum. If not an RN, must hold Masters or Doctoral Degree.

If other than RN, Masters level licensed behavioral health professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. Knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current edition. Ability to analyze specific utilization problems and creatively plan and implement solutions.

5-7 years' experience post degree in a clinical, psychiatric and/or substance abuse health care setting.

Minimum of 5 years of experience conducting utilization management according to medical necessity criteria required.

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About Saviance

Sourced by ZipRecruiter

Saviance is a modern consulting firm providing a variety of professional services to its clients in the US. We bring twenty three years of experience to the table. Our consultants are qualified experts and extremely talented. We understand the business behind the technology, and work with many of the top Fortune 100 companies and provide innovative, scalable, robust and secure solutions. At the forefront of the Staffing and IT Solutions industry, Saviance is certified by NMSDC as a Tier 1, Minority Business Enterprise (MBE) . We are a self- certified Small Business and self- certified Woman Owned Business committed to maximizing global workforce solutions on behalf of our clients, empowering businesses and talent through applied human intelligence. We are a Diversity Supplier with global reach specializing in a business services blend of talent, technology, and a relentless commitment to customer success. It’s our diversity that’s acts as a core component of our culture, our approach to business, and the opportunities we provide to our clients and our employees.

Industry

It services

Company size

201 - 500 Employees

Headquarters location

East Rutherford, NJ, US

Year founded

1999

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