Licensed Clinical Care Reviewer

Job Summary

Working remotely in a full-time capacity, the Licensed Clinical Care Reviewer will process medical necessity reviews for behavioral health services, assist with discharge planning, and coordinate care for members.

Key responsibilities:

• Complete prospective, concurrent, and retrospective reviews of behavioral health services
• Engage with collaborative care partners to facilitate transitions to appropriate levels of care
• Maintain knowledge of state and federal regulations, and identify quality issues for improvement

Required qualifications:

• Associates of Science (A.S) in Nursing, Bachelor of Science (B.S) in Social Work, or a Master's degree in a mental health-related field
• Three (3) years of clinical experience required
• Current, unrestricted licensure as a Registered Nurse (RN) or various mental health licenses required
• MCG Certification required or must be obtained within six (6) months of hire
• Utilization Management/Utilization Review experience preferred