Licensed Clinical Care Reviewer

Job Summary

Responsible for processing medical necessity reviews for behavioral health care services, the full-time Licensed Clinical Care Reviewer will assist with discharge planning and care coordination while working remotely.

Key responsibilities

• Complete prospective, concurrent, and retrospective reviews of behavioral health services
• Coordinate care by engaging with collaborative care partners and medical directors as needed
• Maintain knowledge of regulations and refer quality issues to Quality Improvement and appropriate members for Care Management

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 required
• Three (3) years of clinical experience required
• Current, unrestricted licensure as an RN, LSW, LCSW, LICSW, or equivalent required
• MCG Certification required or must be obtained within six (6) months of hire
• Utilization Management/Utilization Review experience preferred