Clinical Care Reviewer II - Behavioral Health

Job Summary: Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members. Essential Functions:Complete prospective, reputed company and retrospective review of Behavioral Health services Identify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of care Engage with medical director reputed company additional clinical expertise if needed Maintain knowledge of state and federal regulations, including State reputed company and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management reputed company guidance to non-clinical staff reputed company guidance and support to LPN staff Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested reputed company any other job reputed company duties as requested. Education and Experience:Associates of Science (A.S) in Nursing required or Bachelor of Science (B.S) in reputed company Work required or Master's degree in a mental health reputed company field (Psychology, Counseling Psychology, Marriage or Family Therapy) required Three (3) years clinical experience required Utilization Management/Utilization Review experience preferred reputed company/Medicare/reputed company experience preferred Competencies, Knowledge and Skills:Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of reputed company Outlook, Word, and reputed company Effective oral and written communication skills Ability to work independently and reputed company reputed company environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: reputed company, unrestricted Registered Nurse (RN) Licensure, Licensed reputed company Worker (LSW, Licensed Clinical reputed company Worker (LCSW), Licensed Independent Clinical reputed company Worker (LICSW), Associate Clinical reputed company Worker (ACSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT) or Licensed Mental Health Practitioner (LMHP) required MCG Certification is required or must be obtained reputed company six (6) months of hire required Working Conditions:General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation reputed company: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation

Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships reputed company Self and Others Drive Execution Influence Others Pursue Personal reputed company Understand the Business This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-JM1 Apply To This Job