| Application Deadline: Open Until Filled |
Job Location: Portland |
| Date Posted: 11/13/2009 |
Hours Worked Per Week: 40 |
| Computer Skills: N/A
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Shift:
Day Shift
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| Occupational Skills: Preferred |
Duration of Job: Full Time, more than 6 months |
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| Job Summary: |
REQUIREMENTS:
Medical Mgmt Coord I:
* Master Degree in a behavioral health field or psychiatric RN, current state license, 5 years behavioral health clinical experience
* Knowledge of health insurance industry practices related to behavioral health
Medical Mgmt Coordinator II:
Qualifications of a level I PLUS 8 years combined behavioral health clinical experience and health insurance UM or CM experience
JOB DUTIES:
* Perform utilization Management Pre-authorization, Pre-certification, and Concurrent Review
* Perform case Management (pro-active, specialty, and catastrophic)
* Oversee Condition Management, Disease and Maternity Management
* Perform Medical Operations post service, pre and post pay claim review and audit, and member appeals
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| Job Classification: Medical and Health Services Managers |
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| Compensation |
Salary:
Depending on Experience |
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| Job Requirements |
| Experience Required: At least 5 years |
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Education Required: Masters
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Minimum Age: N/A
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Gender: N/A
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