Previous Job
Case Management Senior Analyst (TN)
Ref No.: 20-02537
Location: Nashville, Tennessee
Case Management Senior Analyst (RN, LPC, LAPSW, LCSW or LMFT)
Location: 500 Great Circle Rd, Nashville, TN
Schedule: M-F 8:00 a.m. to 5:00 p.m.
Start Date: 6/8/2020 – 3-month special project 
  • 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.
  • Knowledge of ICD-10 and CPT coding guidelines
  • Familiarity in appropriately applying Level of Care Guidelines, including InterQual and ASAM Criteria, for utilization review.
  • Strong Proficiency in Microsoft Excel, Word and other Microsoft Products is required
  • Utilization Review experience strongly preferred - Would prefer strong computer skills over UM/UR experience
  • Minimum Requirements: Current licensure as a Registered Nurse (RN), Licensed Professional Counselor (LPC) or Licensed Mental Health Practitioner (LAPSW, LCSW or LMFT) in the state of TN or multistate licensure