W3R Consulting ยท 5 hours ago
Behavioral Health Care Coordinator
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Responsibilities
Ensuring accurate and timely clinical review of Behavioral health cases for medical necessity
Assisting members on the telephone on a call queue
Reviewing medical records
Reviewing cases which involve contract interpretation of Behavioral health diagnoses
Utilizing knowledge of medical necessity criteria for all levels of Behavioral health care from outpatient office visits to acute inpatient
Qualification
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Required
Registered Nurse (RN) with active, current license or Masters-level Behavioral Health Professional with active, current license to practice at the independent practice level.
Current clinical license to practice in state of operations and in good standings.
3 years clinical experience in psychiatric setting or own Behavioral health practice.
Verbal and written communication skills.
Analytical and decision-making skills.
PC and database experience.
Preferred
Utilization review experience.