JOB SUMMARY : This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute in-patient to out-patient office visits.
JOB REQUIREMENTS :
- Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, RPsy) with current license to practice at the independent practice level OR Registered Nurse (RN) with Behavioral Health experience.
- Current clinical license in state of operations and in good standings.
- 3 years clinical experience (post licensure at the independent practice level) in psychiatric setting or own behavioral health practice.
- Verbal and written communication skills.
- Analytical and decision making skills.
- PC and database experience.
PREFERRED JOB REQUIREMENTS :
- Utilization review experience.
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