Louisiana Licensed Behavioral Health Reviewer

Job Summary

Conducting clinical reviews of behavioral health service requests, the full-time Louisiana Licensed Behavioral Health Reviewer will assess medical necessity and appropriateness of care while collaborating with the Behavioral Health Medical Director and communicating decisions to providers and members in a remote setting.

Key responsibilities

• Review pre-authorization requests, concurrent reviews, and retrospective claims for behavioral health services
• Apply clinical guidelines to document medical necessity and refer complex cases for secondary review
• Communicate determinations to providers and members through phone and written correspondence

Required qualifications

• Bachelor's degree in nursing, healthcare, or a related field OR master's degree in social work, counseling, or behavioral health
• RN license in Louisiana or LPN license in Louisiana with 2 years of related experience
• At least 3 years of clinical or patient care experience in behavioral health
• Must hold one of the following licenses: LPC, PLPC, LCSW, LMFT, LMSW, LPN, or RN
• Strong clinical assessment and critical thinking skills