Major Job Function:
This position is responsible for the utilization management of Behavioral Health and Chemical Dependency inpatient, partial care, intensive outpatient, and outpatient levels of care as determined by the certification requirements for each line of business. Populations served by this position include the Federal Employee Program (FEP) and commercial PPO members.

Essential Job Functions
1. Perform prospective and concurrent utilization management of Behavioral Health and Chemical Dependency services utilizing ValueOptions, the APA Practice Guidelines.
2. Provide patient and provider assistance and education on utilization management programs, as well as Behavioral Health and Chemical Dependency related questions.
3. Act as a resource person within the department and to other departments in the company regarding Behavioral Health and Chemical Dependency issues.
4. Maintain ongoing compliance with State and Federal laws and URAC standards.

Knowledge, Skills and Abilities
1. Communication skills, both written and verbal.
2. Ability to problem-solve and independently make decisions.
3. Must be able to plan and organize assigned daily work responsibilities.
4. Self motivated to meet goals related to care coordination and member service.

Education, Training and Experience Required
1. Graduation from an accredited school of nursing and a current and valid Registered Nurse license from the State of Nebraska or a state in the consortium in which Nebraska participates are necessary.
2. A Bachelors degree in a health care field is preferred.
3. A minimum of three years of clinical practice experience in a Behavioral Health or Chemical Dependency health care setting is required.
4. Three or more years in utilization management, discharge planning, disease management or case management is preferred.
5. Knowledge of accreditation standards and regulatory requirements is preferred.
6. Ability to use a personal computer which includes typing skills and efficiency in navigating different software systems.
7. Familiarity with software systems such as Word, Excel, and Power Point.