Work Location: This is remote, in Texas. Manager prefers candidates near Austin or San Antonio, but open to Dallas/Fort Worth area. The manager is also open to candidates in NM if necessary
Contract: 2025-05-19 to 2025-12-31
Description:
The position is 100% on a clinical queue. It is staffed only with behavioral health clinicians because they are making clinical decisions to approve treatment requests or send for peer review doc to doc review. The clinicians take incoming calls from providers asking for authorization. There are times a member in crisis is routed to the queue and the clinician will assist the member through their crisis at that time.
- If RN with BH experience, you must have a combo of MCO UM experience, direct care
- Please note that you MUST be licensed to practice at the independent level for this role. The of years of clinical experience required for this role is post licensure ( of years) at the independent level
JOB SUMMARY:
This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute in-patient to out-patient office visits.
JOB REQUIREMENTS:
- Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, RPsy) with current license to practice at the independent practice level OR Registered Nurse (RN) with Behavioral Health experience
- Current clinical license in state of operations and in good standings.
- 3 years clinical experience (post licensure at the independent practice level) in psychiatric setting or own behavioral health practice.
- Verbal and written communication skills.
- Analytical and decision-making skills.
- PC and database experience.
PREFERRED JOB REQUIREMENTS:
- Utilization review experience.