Remote Behavioral Health & Utilization Management (RN) – TX, IL, NM
Job Overview
- Clinical License RN
- State(s) IL, NM, TX
Full job description
Position:- Behavioral Health & Utilization management
Rate:- $40/hr.
Location:- Fully Remote ( TX, IL, NM)
Description:
BASIC FUNCTION:
This position is responsible for facilitating all aspects of assigned clinical quality improvement projects, quality auditing, quality reporting; consults with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implement, coordinate, monitor and evaluate options and services required to meet clinical quality improvement project/audits/reporting objectives; uses available resources to promote high quality and cost effective outcomes. This position is responsible for coordinating quality reviews, audits and projects in compliance with accreditation and regulatory agency requirements
ESSENTIAL FUNCTIONS:
1. Perform on-site or electronic medical record reviews to evaluate delivery of care in relation to clinical practice guidelines or state regulations.
2. Responsible for facilitating and monitoring of assigned quality improvement projects, including the following:
- Consult with network physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implement, coordinate, monitor and evaluate options to meet clinical quality improvement project/auditing/reporting objectives and to promote high quality and cost-effective outcomes.
- Gather information, analyzes and communicates it, and develops recommendations regarding clinical quality improvement projects/audits/reports.
- Assist in addressing issues related to clinical quality improvement projects/audits/reports for the managed care programs to assure compliance with contractual arrangements, accreditation requirements, government regulations and employer group expectations.
- 3.Behavioral Health providers and other practitioners, as well as the state regarding existing and proposed clinical quality improvement initiatives and results.
4. Assist in development, implementation, and evaluation of effectiveness of population-based programs. Participate in activities such as literature review to identify appropriate recommendations for quality improvement initiatives, population assessment, and development of data collection tools.
5. Facilitate action plan activities related to assigned programs, coordinate with internal and external resources to meet program targets and objectives.
JOB REQUIREMENTS:
- Registered Nurse (RN) or Masters-level Behavioral Health Professional with independent practice license. License is current, valid in the state of operations and in good standing.
- 3 years clinical practice experience.
- 2 years Utilization Management, Case Management, quality improvement and/or project management experience.
- Experience conducting presentations for member and/or provider training.
- Knowledge of behavioral health or managed care products and programs.
- PC proficiency to include Word and Excel.
Job Type: Contract
Pay: From $40.00 per hour
Expected hours: 40 per week
Schedule:
- 8 hour shift
Experience:
- Behavioral Health: 1 year (Required)
- Utilization review: 1 year (Preferred)
License/Certification:
- State License of IL/TX/NM (Preferred)
Work Location: Remote