Job Summary
A company is looking for a Behavioral Health Utilization Management Clinician.
Key Responsibilities
- Review clinical information to ensure it meets Medical Necessity Criteria for service authorization
- Maintain knowledge of medical necessity criteria, clinical protocols, and compliance requirements
- Ensure accurate information is entered into the claims system for payment processing
Required Qualifications, Training, and Education
- Bachelor of Science in Nursing, Masters of Counseling, or Masters of Social Work required
- LCSW, LPC, or RN current license for the state of Virginia required
- 2 years of clinical experience required
- 2 years of experience in behavioral health and 1 year in care coordination or transitions of care required
- Experience in substance abuse and utilization management required
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