LyTorre is The Difference – in step with patients and families to build connections and trust.LyTorre is The Difference
Learn More
Social Worker
Utilization Mgmt SW
Houston, TX, US
We are searching for a Utilization Management Social Worker. Someone who will provide prior authorization of outpatient and inpatient behavioral health services requiring authorization. This process includes using clinical judgement for utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing evidence-based criteria. In addition, provider education is a component of this process.
Think you have what it takes?
Qualifications:
- Master's Degree Social Work Licenses and Certifications Req Pref Enter Licenses/Certifications Licensing Authority
- LMSW - Licensed Master Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LCSW - Lic Clinical Social Worker Texas Behavioral Health Ex Council (TBHEC) Or LMSW-AP - Lic Master Social Worker - Adv Pract Texas Behavioral Health (TBHEC) Experience Req
- 3 years Behavioral Health clinical experience required
- 2 years Managed Care Experience required
- 2 years Utilization Mgmt preferred
Responsibilities:
- Assess the treatment plan, clinical information, and medical necessity of all requested services
- Facilitates provider communication and education.
- Liaisons with internal and external managed care staff members.
- Assess and refers potential case management cases
- Ongoing assessment for quality indicators and concerns.
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
