Behavioral Health Utilization Specialist

Come Find your Spark at Quartz! We are seeking an experienced Behavioral Health Utilization Specialist to join our Behavioral Health Team. The Behavioral Health Utilization Specialist will provide utilization management of behavioral health services, conducts clinical review of authorization requests, and supports members and providers in identifying appropriate types and levels of care. This role will be responsible for making referrals to appropriate services and for providing consultation to members, primary care physicians, and other healthcare providers.

Benefits:

Work independently while enjoying the benefits of collaborating with a team
• Make a direct, positive impact on the behavioral health care that our members receive
• Serve as an educator and influencer in behavioral health for the organization and across the communities that we serve
• Starting salary based upon skills and experience: $65,300 - $81,700 plus robust benefits package

• Manages the utilization of mental health and/or substance use disorder services by assessing members' needs for services through telephone interviews, clinical documentation review, and collaboration with treating providers.
  • Utilizes clinical judgement and knowledge in applying medical necessity criteria guidelines or internally derived policies to determine the medical necessity of treatment requests requiring prior authorization and concurrent review.
  • Obtains accurate and detailed clinical information from appropriate sources to facilitate clinical review of cases.
  • Makes authorization determinations, notifications, and maintain documentation in accordance with quality and contractual standards, regulations, and guidelines.
  • Assists members, participants, and providers in identifying treatment options according to member networks and members' treatment needs.
  • Provides care coordination on high-risk, high-cost, complex cases.

• Bachelor's degree in Nursing with 5 years post-bachelor's degree experience within a behavioral health care setting
• OR Master's degree in mental health related field with 3 years of post-master's degree experience within a behavioral health care setting
• With Bachelor's degree, a Registered Nurse in the state of WI, With Master's degree, a licensed mental health professional in the state of WI
• Eligibility for licensure in the states of IL, MN, or IA is strongly preferred.
• Knowledge of the delivery of behavioral health services in a managed care environment
• Excellent interviewing and assessment skills
• Strong independent critical thinking skills to understand member and operational problems and assists in identifying appropriate resolution
• Create strong relationships and provide positive experiences for internal stakeholders
• Excellent organizational and interpersonal skills

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.