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Case Management Senior Analyst
Ref No.: 19-06191
Location: Nashville, Tennessee
Title: Case Management Sr. Analyst
Pay: $30-$40 an hour
Location: Nashville, TN
Schedule: M-F, regular business hours (typically 8am-5pm)
Start: 9/30/2019 (4 months)
The Case Management Sr. Analyst performs utilization management duties for *****-HealthSpring members following national and state clinical guidelines for inpatient and outpatient Medicare and Medicaid covered services.  Participates in the discharge planning process and identifies appropriate resources both internal and external required for a successful transition of care to an alternative setting.
Job Description:
  • Responsible for the effective and sufficient support of all behavioral utilization activities for several markets according to policies and procedures. 
  • Will focus on utilization management of Medicare and Medicaid covered Behavioral Health requests. 
  • Refers cases to the Medical Director as appropriate. 
  • Evaluates and refers cases to quality of care, disease management, and case management programs as needed. 
  • Assists with discharge planning. 
  • Maintains strong working relationship with internal and external customers. 
  • Professionally communicates information as needed or required.  
  • Documents information into the clinical management system.
  • Supports the *****-HealthSpring Behavioral Health Unit providing data and identifying improvement opportunities
  • Current licensure as a Registered Nurse (RN), Licensed Professional Counselor (LPC) or Licensed Mental Health Practitioner (LAPSW, LCSW or LMFT). 
  • At least three years clinical experience required and at least two years in utilization review preferred. 
  • Knowledge of ICD-10 and CPT coding guidelines. 
  • Familiarity in appropriately applying Level of Care Guidelines, including InterQual and ASAM Criteria, for utilization review.
  • Managed care experience.