Job Summary
A company is looking for a Behavioral Health Utilization Management Clinician (LCSW/LPC/LMFT/RN) for a remote position in Virginia and North Carolina.
Key Responsibilities
- Review clinical information to ensure it meets Medical Necessity Criteria for service authorization
- Maintain knowledge of medical necessity criteria and compliance requirements for various payers
- Ensure accurate information is entered into the claims system for payment processing
Required Qualifications, Training, and Education
- Master's Degree in Social Work or Counseling Field, or Bachelor's Degree in Nursing is required
- Current license as LCSW, LPC, LMFT, or RN in Virginia is required
- Minimum of 2 years of clinical experience is required
- 2 years of experience in behavioral health and 1 year in care coordination or transitions of care is required
- 1 year of case management experience is preferred
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