Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC

About the role

The Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN will review clinical information from providers to ensure it meets Medical Necessity Criteria for authorization of services. They will also ensure appropriate and accurate information is entered into the claims system for payment processing.

Responsibilities

• Review clinical information from providers to ensure it meets Medical Necessity Criteria for authorization of services.
• Avoid inappropriate or inaccurate information being entered into the claims system for payment processing.
• Ensure contractual, regulatory, and compliance requirements for government payers, self-funded, and commercial payers are adhered to.
• Ensure appropriate and accurate information is entered into the claims system for processing of payment.
• Knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols, and clinical review requirements.
• Knowledge of contractual, regulatory, and compliance requirements for government payers, self-funded, and commercial payers.
• Experience in substance abuse in ASAM levels of care and utilization management preferred.

Requirements

• Master’s degree in Counseling, Social Work, or Marriage and Family Therapy REQUIRED
• One of the following licenses is REQUIRED: LCSW, LPC, LMFT, RN
• 2 years of behavioral health experience REQUIRED
• 1 year of case management experience REQUIRED

Qualifications

• Experience in substance abuse in ASAM levels of care and utilization management preferred

Skills

• Knowledge of medical necessity criteria for behavioral health and substance use services
• Knowledge of contractual, regulatory, and compliance requirements for government payers, self-funded, and commercial payers
• Experience in substance abuse in ASAM levels of care and utilization management

Benefits

• Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Pay

Commensurate with experience

Schedule

Flexible dayshift; Can start from 6am to 9am EST, M-F