LMSW Behavioral Health Reviewer

Job Summary

A company is looking for a Behavioral Health Utilization Management Reviewer.

Key Responsibilities

• Apply medical necessity criteria to authorize services and refer requests to the Medical Director as needed
• Ensure treatment is appropriately utilized and meets member needs in the least restrictive manner
• Maintain knowledge of laws, regulations, and policies relevant to the organizational unit's business

Required Qualifications, Training, and Education

• Registered Nurse candidates: Associate Degree in Nursing (required) or Bachelor Degree in Nursing (preferred)
• Licensed Social Work candidates: Master Degree in Social Work
• Minimum of 2 years of behavioral health and substance use disorder experience in a clinical setting
• Proficiency using InterQual and ASAM criteria
• Active and unencumbered professional licensure for LMSW candidates; active RN license for Registered Nurse candidates