Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
A Behavioral health Utilization Management Reviewer is responsible for the timely coordination of quality behavioral health and substance use disorder treatment services for plan membership in a cost-effective manner to promote positive outcomes. Performs utilization and care coordination for members with behavioral health needs and substance abuse disorders by assessing levels of care, and by developing, implementing, coordinating, monitoring, and evaluating plan of care designed to optimize member’s treatment across the continuum. Evaluates requests for services for clinical appropriateness and medical necessity. Responsible for authorizing cases according to approved criteria across the continuum of care to ensure a positive member outcome while controlling costs by performing inpatient and outpatient reviews, and identification and referral of members appropriate for case management.
Medical Management educates members and empowers them to become active participants in their coordinated health care plans. This team of knowledgeable professionals in their field provide services to include Utilization Review, Medical Outreach, Case Management, Disease Management, Credentialing, Social Work as well as Grievance and Appeals
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!