• Liaise with clients to establish a collaborative environment, developed clear lines of communication, and maintain positive client relations.
• Provide leadership and direction to utilization review personnel to ensure a high level of client satisfaction.
• Using project management skills and principles determine requirements, maintain metrics, and deliver project plans.
• Serve as clinical Subject Matter Expert for utilization review personnel to resolve issues and streamline solutions.
• Ensure that pre-approved criteria and guidelines to validate medical necessity processes are followed.
• Oversee the performance of on-site and/or telephonic review of psychiatric services.
• Work with the Medical Director to identify and resolve any quality or utilization issues.
• Provide utilization management education as required to a diverse group of health care providers.
 

 • Bachelor's degree in nursing, public health, social work, or related field; master's degree or utilization certification preferred
• Unrestricted RN license in the State of Ohio
• Minimum of 5 years utilization management experience
• Psychiatric care knowledge or experience
• Project management and leadership aptitude
• Excellent oral and written communications skills
• Ability to travel up to 40% throughout the State of Ohio