Behavioral Health UM Care Manager (RN) - Part Time

Responsibilities: Perform utilization reviews and clinical assessments to ensure members receive covered services in the most cost-effective and appropriate settings. Coordinate safe discharge transitions from inpatient settings by collaborating with providers, clinicians, and medical directors.

Requirements: Requires a Registered Nurse license and a minimum of 2 years of experience in clinical or case management nursing. A BSN or MSN and prior experience in utilization management or psychiatric care are strongly preferred.

Key skills: Utilization Review, Case Management, Discharge Planning, Clinical Assessment, Medical Necessity Review, Interqual, Mahalik, Behavioral Health, Patient Coordination, Medical Terminology, Computer Proficiency, Problem-solving

Keywords: Utilization Management, RN, Behavioral Health, Interqual, Mahalik, Case Management Certification, Discharge Planning, Medical Necessity, Clinical Review, UPMC Health Plan, Durable Medical Equipment, Private Duty Nursing, Act 34, Nursing Licensure Compact