Utilization Management Clinician - CCR/BH

Responsibilities:

• Processes acute and post-acute inpatient medical or behavioral health requests.
• Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies.
• Performs high acuity of care UM case reviews within the framework of applicable regulatory requirements.

Skills:

• Communication, technical, analytical, organizational and other unique skills required to succeed in the position.
• Ability to critically think through processes to make clinically appropriate decisions and problem solve.
• Ability to prioritize multiple clinical and administrative tasks and assignments.

Experience:

• A minimum 5 years’ experience working in a higher level of care clinical role.
• 1 year UM experience in managed care required.