Job Title: Telecommuter Behavioral Health Review Specialist
This is a telecommuter role based in Albuquerque, Chicago, Richardson, and Tulsa headquarters.
Position Details:
Part-Time, Exempt status - 32 hours/week.
Work schedule includes evenings and weekends.
Weekly schedule: one 8-hour shift on Friday night from 12:30 am to 8:30 am (Saturday morning), and two 12-hour shifts on Saturday and Sunday nights from 8:30 pm to 8:30 am.
Must Have: At least 3 years of clinical experience post-licensure at the independent practice level in a psychiatric setting, outpatient facility, or own behavioral health practice.
Job Summary:
This role involves ensuring accurate and timely clinical review of behavioral health cases for medical necessity. Responsibilities include assisting members via telephone, reviewing medical records, interpreting behavioral health diagnoses, and applying knowledge of medical necessity criteria across all levels of behavioral health care, from outpatient visits to inpatient stays.
Job Requirements:
Registered Nurse (RN) with a current license or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, RPsy) with a current independent practice license.
Current clinical license in the state of operation, in good standing.
At least 3 years of clinical experience in a psychiatric setting or own behavioral health practice.
Strong verbal and written communication skills.
Analytical and decision-making skills.
Proficiency with PC and database management.
Preferred Qualifications:
Utilization review experience.
Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.