TRICARE Behavior Health Utilization Manager - Colorado Springs, CO

For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

UnitedHealthcare Military and Veterans is currently seeking a Behavioral Health Care Manager (BHCM) is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management and intermediate Partial and Residential Care). The BHCM performs reviews of current inpatient services and intensive Mental Health and Substance Abuse services, and determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed.  The BHCM staff works under the direct supervision of UM Manager or MD.

Primary Responsibilities:

• Perform care management activities to ensure that patients move through the continuum of care efficiently and safely


• Assess and interpret customer needs and requirements


• Review cases and analyze clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization


• Perform Clinician to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plan


• Escalate cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate


• Perform anticipatory discharge planning in accordance with the patient's benefits and available alternative resources


• Collaborate with Medical peers on consideration of discharge planning needs


• Refer patients to disease management or case management programs


• Assist with the development of treatment plans


• Document activities according to established standards


• Identify solutions to non-standard requests and problems


• Solve moderately complex problems and/or conduct moderately complex analyses


• Work with minimal guidance; seek guidance on only the most complex tasks


• Provide explanations and information to others on difficult issues


• Act as a resource for others with less experience


• Work with less structured, more complex issues

Required Qualifications:

• Current unrestricted license in a mental health field i.e.: LCSW, LMFT or unrestricted RN License in state of residence


• 2+ years previous experience in Utilization Management


• 5+ years of clinical experience in an inpatient/acute setting or outpatient setting


• Intermediate to Advanced computer skills-Microsoft Word, Outlook and Internet Explorer with the ability to navigate a Windows environment


• United States Citizenship


• Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86


• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action


• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others


• Strong organizational skills


• Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans


• Drive performance and achieve targets

Preferred Qualifications:

• Previous TRICARE experience


• Prior Military experience


• Knowledge of Level of Care Guidelines


• Prior Utilization Review experience


• Experience in discharge planning and/or chart review


• Experience in acute long term care, acute rehabilitation, or skilled nursing facilities


• A background that involves utilization review for an insurance company or in a managed care environment


• Prior Military experience

As a requirement of UnitedHealth Group's contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 http://www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or “NAC”).  Successful completion of the NAC process is a requirement for continued employment in this role.  NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense.  Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received.  Failure to obtain final NAC approval will result in termination from this role.

Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That's why UnitedHealthcare is the organization that's called on to serve them and their loved ones. We're all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It's a genuine opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: Utilization Management, UM, Behavioral Health, Mental Health, CM, LCSW, Licensed Clinical Social Worker, LMFT, Licensed Marriage Family Therapist, clinical, RN, Registered Nurse, Nurse, TRICARE, military, Colorado Springs, CO