Nevada Licensed Behavioral Health Advocate

Job Summary

A company is looking for a Behavioral Health Senior Care Advocate to support the behavioral health needs of members across various lines of business.

Key Responsibilities:

• Conduct utilization reviews for behavioral health services using established medical necessity criteria
• Evaluate clinical information to determine medical necessity and level of care
• Review and process medical necessity and administrative denials and manage appeals cases

Required Qualifications:

• RN or Master's degree in social work or a related behavioral health field
• Active, unrestricted behavioral health license in the state of Nevada
• 3+ years of behavioral health clinical experience in inpatient or outpatient settings
• Familiarity with Medicaid and Commercial benefit structures and utilization management protocols
• Proficient in using clinical systems and electronic documentation platforms