Ohio Licensed Behavioral Health Reviewer

Job Summary

Working remotely, the full-time Ohio Licensed Behavioral Health Reviewer will conduct medical necessity reviews for inpatient and outpatient services, collaborating with providers and members to gather essential information and ensure appropriate service approvals.

Key responsibilities

• Perform thorough medical necessity reviews and utilize clinical judgment to evaluate provider requests
• Coordinate care opportunities and refer cases to integrated care management as needed
• Maintain knowledge of relevant laws, regulations, and policies while applying medical health benefit policy and management guidelines

Required qualifications

• Active and unencumbered professional licensure in Ohio as a Licensed Social Worker (LSW) or Registered Nurse (RN)
• Master's Degree in Social Work or Associate's Degree in Nursing (Bachelor's preferred)
• Minimum of 2 years of independent clinical practice experience with substance use or co-occurring disorders
• Utilization management experience in a managed care organization is preferred
• Ability to obtain additional licensure in LA, NC, NH, and DC within 12 months from hire date