This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involve contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute inpatient.

JOB REQUIREMENTS:

• Bachelor of Social Work or Psychology OR LVN, LPN with 1 year experience in managed care systems OR RN OR 3 years care coordination for a state managed or waiver program OR 3 years managed care systems experience.

• 3 years clinical experience in psychiatric setting or own behavioral health practice.

• Remote but needs to be within the area

• Verbal and written communication skills.

• Analytical and decision making skills.

• PC and database experience.

Job Type: Full-time

Salary: $25.00 - $28.00 per hour

Schedule:

• 8 hour shift

Work setting:

• In-person

Experience:

• Psychiatric care: 3 years (Required)

Work Location: In person