Licensed Behavioral Health Reviewer

Job Summary

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