Job Summary
Supports the Utilization Management Program by applying effective and efficient processes for determining over/under-utilization and appropriateness of services for both medical and behavioral benefits to promote the highest level of physical, psychological, and social functioning possible for members and their families. Under direction from the Chief Medical Officer and Medical Director, conducts prospective, concurrent, and/or retrospective utilization review functions. Identify members with special healthcare needs, and ensure timely referrals are completed for coordination of services and/or community resources. Maintains attuned to the identification of social determinants of health and refers Members, as necessary, to address their needs.
Skills
1. Excellent verbal, written, and interpersonal communication skills required as demonstrated by past job experience.
2. Strong analytical, data management and computer skills.
3. Able to work with people of all social, economic, and cultural backgrounds.
4. Flexible, open-minded and adaptable to change.
5. Understanding of pre-acute and post-acute venues of care and community resources.
6. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
7. Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
8. Ability to interpret policies and procedures and communicate complex topics effectively.
9. Computer and typing skills required.
10. Bilingual in English and Spanish preferred.
Work Experience
Two years of clinical experience required.
License/Registration/Certification
Current, active, unrestricted license to practice as Licensed Nurse, Social Worker, Therapist, or BH Counselor in the State of Texas required.
Education and Training
Associate Licensed Nurse or bachelor degree in health care related field required.
Location: University Medical Center of El Paso · EPH Health Services
Schedule: Full Time, Days