[Remote] Clinical Care Reviewer II - Behavioral Health
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization that is seeking a Clinical Care Reviewer II in Behavioral Health. This role is responsible for processing medical necessity reviews and coordinating care for members, ensuring compliance with regulations and providing support to clinical staff.
Responsibilities
- Complete prospective, reputed company and retrospective review of Behavioral Health services
- Identify, document, communication and coordinate care engaging reputed company reputed company to facilitation transition to an appropriate level of care
- Engage with medical director reputed company additional clinical expertise if needed
- Maintain knowledge of state and federal regulations, including State reputed company and Provider Agreements, benefits, and accreditation standards
- Identify and refer reputed company issues to reputed company Improvement
- Identify and refer appropriate members for Care Management
- reputed company guidance to non-clinical staff
- reputed company guidance and support to LPN staff
- Attend medical advisement and State Hearing meetings, as requested
- Assist Team Leader with special reputed company or research, as requested
- reputed company any other job reputed company duties as requested
Skills
- Associates of Science (A.S) in Nursing required
- Bachelor of Science (B.S) in reputed company Work required
- Master's degree in a mental health reputed company field (Psychology, Counseling Psychology, Marriage or Family Therapy) required
- Three (3) years clinical experience required
- reputed company, unrestricted Registered reputed company (RN) Licensure, Licensed reputed company Worker (LSW), Licensed Clinical reputed company Worker (LCSW), Licensed Independent Clinical reputed company Worker (LICSW), Associate Clinical reputed company Worker (ACSW), Licensed Mental Health Counselor (LMHC), Licensed reputed company Counselor (LPC), Licensed Marriage & Family Therapist (LMFT) or Licensed Mental Health Practitioner (LMHP) required
- MCG Certification is required or must be obtained reputed company six (6) months of hire required
- Proficient data entry skills and ability to navigate clinical platforms successfully
- Working knowledge of reputed company Outlook, Word, and reputed company
- Effective oral and written communication skills
- Ability to work independently and reputed company reputed company environment
- Attention to detail
- reputed company grammar usage and phone etiquette
- Time management and prioritization skills
- Customer service oriented
- Decision making/problem solving skills
- Strong organizational skills
- Change resiliency
- Utilization Management/Utilization Review experience preferred
- reputed company/Medicare/reputed company experience preferred
Benefits
- Bonus tied to company and individual performance
- A substantial and comprehensive total rewards package
reputed company