Utilization Management Clinical Specialist
Sheppard Pratt CareersTowson, Maryland
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Overview
Schedule
Full-time
Education
Nursing (RN, LPN)
Social Work (LSW, LMSW, LICSW)
Career level
Senior-level
Remote
On-site
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Job Description
What to expect:
- Provides timely, comprehensive utilization reviews for behavioral health services for Sheppard Pratt patients.
- Conducts medical reviews for inpatient and partial hospitalization programs, maintains accurate documentation within hospital data systems, and communicates effectively with internal stakeholders and external agencies.
- Coordinates with Medicare, Medicaid, and Commercial Health Plans to ensure compliance with CMS (Centers for Medicare & Medicaid Services), Maryland Medicaid, and payer-specific requirements.
- Leads the appeals process through data-driven analysis, optimized workflows, and strengthened clinical documentation to support medical necessity decisions and successful appeal outcomes.
What you’ll get from Us:
At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:
- A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
- Comprehensive medical, dental and vision benefits for benefit eligible positions
- 403b retirement match
- Generous paid-time-off for benefit eligible positions
- Complimentary Employee Assistance Program (EAP)
- Generous mileage reimbursement program
Pay for this position is determined on a number of factors, including but not limited to, years and level of related experience.
What we need from You:
- Associate or Bachelor’s degree in nursing, Bachelor’s or Master’s degree in Clinical Counseling, Healthcare Administration, or related clinical field.
- Active RN license, Licensed Clinical Professional Counselor (LCPC), or Licensed Certified Social Worker-Clinical (LCSW-C).
- Minimum of 3-5 years of experience in utilization management, or behavioral health.
- Strong knowledge of payer requirements, clinical criteria and behavioral health diagnosis.
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FAQs About Utilization Management Clinical Specialist Jobs at Sheppard Pratt Careers
What is the work location for this position at Sheppard Pratt Careers?
This job at Sheppard Pratt Careers is located in Towson, Maryland, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Sheppard Pratt Careers?
Employer has not shared pay details for this role.
What employment applies to this position at Sheppard Pratt Careers?
Sheppard Pratt Careers lists this role as a Full-time position.
What experience level is required for this role at Sheppard Pratt Careers?
Sheppard Pratt Careers is looking for a candidate with "Senior-level" experience level.
What education level is required for this job?
The education requirement for this position includes Nursing (RN, LPN) and Social Work (LSW, LMSW, LICSW). Candidates with relevant qualifications or equivalent experience may also be considered.
What benefits are offered by Sheppard Pratt Careers for this role?
Sheppard Pratt Careers offers following benefits: Health Insurance, Dental Insurance, Vision Insurance, Paid Vacation, Career Development, 401k Matching/Retirement Savings, Tuition/Education Assistance, and Health & Wellness Programs for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at Sheppard Pratt Careers?
You can apply for this role at Sheppard Pratt Careers either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.