Clinician

• Perform clinical reviews and assess care related to mental health and substance abuse
• Monitor and determine whether levels of care and services are medically appropriate
• Support utilization management and quality improvement efforts
• Identify outlier provider performance
• Conduct comprehensive clinical record reviews
• Deliver individualized coaching to providers
• Synthesize findings into actionable presentations for providers and health plan leadership
• Evaluate member treatment before, during, and after services
• Perform prior authorization reviews according to regulatory guidelines and criteria
• Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
• Analyze behavioral health member data to improve quality and appropriate utilization
• Educate providers, members, and families regarding the behavioral health utilization process
• Discuss levels of care and services with behavioral health healthcare providers
• Engage medical directors and leadership to improve care quality and efficiency
• Formulate and present cases in staffing and integrated rounds
• Comply with all policies and standards
• Perform other duties as assigned

Clinician jobs in Kansas

Utilization Review Clinician – Behavioral Health