Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - Behavioral Health.

Key Responsibilities

• Process medical necessity reviews for behavioral health services and assist with discharge planning activities
• Coordinate care with collaborative partners and engage with medical directors for additional clinical expertise as needed
• Maintain knowledge of regulations and identify quality issues for referral to Quality Improvement and Care Management

Required Qualifications, Training, and Education

• Associates of Science (A.S) in Nursing or Bachelor of Science (B.S) in Social Work required
• Three (3) years of clinical experience required
• Utilization Management/Utilization Review experience preferred
• Medicaid/Medicare/Commercial experience preferred
• Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required