Utilization Mgmt SW

Texas Children's
Bellaire, TX
Category Human Resources
Job Description
Texas Children's Health Plan is seeking a Utilization Management Social Worker to provide prior authorization for outpatient and inpatient behavioral health services. The role involves clinical judgment, utilization management, benefit application, regulatory understanding, and verification of medical necessity, along with provider education. The ideal candidate will have a strong understanding of Texas regulations and clinical experience in behavioral health.

Requirements

  • Master's Degree Social Work Licenses and Certifications
  • LMSW - Texas Behavioral Health Ex Council
  • LCSW - Texas Behavioral Health Ex Council
  • LMSW-AP - Texas Behavioral Health Ex Council
  • 3 years Behavioral Health clinical experience
  • 2 years Managed Care Experience
  • 2 years Utilization Mgmt preferred
  • Experience requring Texas regulations

Benefits

  • Star/Medicaid
  • Children's Health Insurance Program (CHIP)
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