Licensed Behavioral Health Clinician
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Job Summary
To support our inpatient and outpatient Behavioral Health Medicare Plan, the full-time remote Utilization Review Clinician - Behavioral Health will perform clinical reviews, assess care related to mental health and substance abuse, and determine the medical appropriateness of services.
Key responsibilities:
- Evaluate members' treatment for mental health and substance abuse to ensure the appropriateness of care levels
- Perform prior authorization reviews and concurrent reviews for behavioral health inpatient services
- Analyze behavioral health member data to enhance service quality and utilization
Required qualifications:
- Master's degree required for behavioral health clinicians
- License to practice independently, such as LCSW, LMHC, LPC, LMFT, or LMHP
- 2-4 years of related experience in behavioral health or utilization management
- Strong knowledge of medical necessity criteria and managed care principles
- Experience working with healthcare teams to review care services related to mental health and substance abuse preferred
Complete Job Description
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