Ohio Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - RN - BH - MSL.

Key Responsibilities

• Process medical necessity reviews for behavioral health care services and coordinate discharge planning activities
• Maintain knowledge of regulations and standards while monitoring the delivery of behavioral healthcare services
• Provide guidance to medical management staff and assist with special projects or research as needed

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program or Bachelor's Degree in Social Work
• Minimum of three (3) years of clinical experience required
• Utilization Management/Utilization Review experience preferred
• Medicaid/Medicare/Commercial experience preferred
• Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required