Job Summary

A company in the healthcare industry is seeking a Behavioral Health Utilization Management Reviewer.

Position Responsibilities:

• Complete medical necessity reviews for inpatient and outpatient services
• Evaluate requests to ensure appropriate services are approved and recognize care coordination opportunities
• Maintain current knowledge and understanding of laws, regulations, and policies related to the business unit

Required Qualifications:

• Bachelor's or Master's degree in related field
• Registered Nurse graduate from an accredited institution with an Associate Degree or Bachelor's Degree considered, or Master's Degree and independently licensed in social work, marriage and family counseling or professional counseling required
• Clinical knowledge and experience in the behavioral health field
• Ability to apply medical health benefit policy and medical management guidelines to authorize services
• Knowledge of laws, regulations, and policies related to healthcare industry