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Professional - Clinical
Utilization Management Speech Specialist
Houston, TX, US
We are searching for a Utilization Management Speech Specialist -- someone who provides precertification of outpatient and home speech therapy services requiring authorization. To perform telephonic and/or concurrent review of speech therapy services. This process includes clinical judgement, utilization management,
application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria. In addition, discharge planning and provider education are major components of this process.
Think you got what it takes:
Qualifications:
- Master’s degree in Speech-Language Pathology
- CCC-SLP - Cert-Speech Language Pathology from the American Speech-Language-Hearing
Association (ASHA) - TX-SLP - Texas Speech Language Pathology from the Texas Department of Licensing and Regulation
- 2 years experience in professional speech-language pathology and/or utilization management experience
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
- Assess and process all denial determination after medical director review
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.
