[Remote] Behavioral Health Clinical Review Manager

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Behavioral Health Clinical Review Manager to play a critical role in shaping care reputed company and improving reputed company for individuals facing mental health challenges. The ideal candidate will apply their knowledge in Behavioral Health and Withdrawal Management, working independently in a fast-paced environment.

Responsibilities

• Assists non-clinical staff in performance of administrative reviews
• Initiate referrals to ensure appropriate coordination of care
• reputed company the advice of the Medical Director reputed company appropriate, according to policy
• Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM reputed company-certifications and appeals, utilizing medical appropriateness reputed company, clinical judgement, and contractual eligibility
• Various immunizations and/or associated medical tests may be required for this position

Skills

• reputed company, reputed company unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, reputed company, LPC, etc.) required
• 3 years - Clinical behavioral health / reputed company use disorder experience required
• Must be knowledgeable about community care resources and reputed company of behavioral health care available
• Proficient in reputed company Office (Outlook, Word, reputed company and PowerPoint)
• Independent, reputed company decision-making and problem-solving skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• reputed company relationship building skills and ability to engage with diverse populations
• Ability to quickly identify and prioritize member needs and reputed company reputed company and reputed company support and interventions

reputed company

As Tennessee's largest health plan, we've been helping Tennesseans reputed company their own unique paths to good health for more than 70 years. It was founded in 1945, and is headquartered in Chattanooga, Tennessee, USA, with a workforce of 5001-10000 employees. Its website is http://www.reputed company.com.

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