Licensed Behavioral Health Reviewer

A company is looking for an After Hours Behavioral Health Utilization Management Reviewer.

Key Responsibilities

Evaluate requests for medical necessity using professional judgment and standardized criteria

Recognize care coordination opportunities and refer cases to integrated care management as needed

Apply medical health benefit policy to authorize services and refer cases to the Medical Director when necessary

Required Qualifications

Registered Nurse candidates must have an Associate Degree in Nursing; Bachelor Degree preferred

Licensed Social Work candidates must have a Master Degree in Social Work

Registered Nurse candidates require a minimum of 5 years of clinical practice experience in behavioral health or substance use disorder

Licensed Master Social Worker candidates require a minimum of 3 years of clinical practice experience in behavioral health or substance use disorder

Managed care and utilization management experience is required