After Hours Behavioral Health Reviewer

Job Summary

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

Key Responsibilities

• Evaluate service requests using professional knowledge and standardized criteria to ensure appropriate service approvals
• Recognize care coordination opportunities and refer cases to integrated care management as needed
• Apply medical health benefit policy to authorize services and refer requests to the Medical Director when required

Required Qualifications and Education

• Registered Nurse candidates must have a minimum of 5 years of clinical practice experience in behavioral health and/or substance use disorder
• Licensed Master Social Worker candidates must have a minimum of 3 years of clinical practice experience in behavioral health and/or substance use disorder
• Managed care and utilization management experience is required
• Associate Degree in Nursing with an unencumbered RN license; Bachelor's Degree in Nursing preferred
• Master's Degree in Social Work and independently licensed in social work, marriage and family counseling, or professional counseling