Mental Health and Substance Abuse Utilization Expert
3 weeks ago
We are seeking a highly skilled Clinical Professional to join our Medical Management team.
Role Summary:This role is responsible for performing clinical reviews to assess mental health and substance abuse care, ensuring that services are medically appropriate and meet regulatory guidelines.
Key Responsibilities:- Evaluate members' treatment plans for mental health and substance abuse before, during, and after services to ensure they are medically necessary.
- Conduct prior authorization reviews for mental health and substance abuse services to determine medical appropriateness in accordance with regulatory requirements.
- Review behavioral health inpatient care to determine overall member health, treatment needs, and discharge planning.
- Analyze behavioral health member data to improve quality and efficient utilization of services.
- Provide education to providers, members, and their families regarding behavioral health utilization processes.
- Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience.
- Licensure to practice independently and/or state-required licensure.
- Masters degree required for behavioral health clinicians.
- Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
- Knowledge of mental health and substance abuse utilization review process preferred.
- Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.
$25.97 - $46.68 per hour
Benefits:We offer a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements.
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