Licensed Clinical Reviewer - NM

Job Summary

A company is looking for a Clinical Reviewer III, Behavioral Health - Remote NM.

Key Responsibilities

• Conducts treatment record and case management record reviews, analyzing clinical documentation
• Monitors quality of care standards and prepares performance reports
• Assists in planning and implementing service delivery improvements and provides training for clinical staff

Required Qualifications, Training, and Education

• RN/BSN or clinical credentials in a behavioral health field; if not an RN, a Master's or Doctoral Degree and a licensed behavioral health professional is required
• 7 or more years of experience in a clinical, psychiatric, and/or substance abuse healthcare setting
• Minimum of 4 years of experience in utilization management according to medical necessity criteria
• Knowledge of ICD and DSM IV coding or the most current edition
• Ability to use computer systems effectively