Clinical Care Reviewer - Behavioral Health Utilization Management Revi
Location: Baton Rouge
Posted on: December 7, 2018
Clinical Care Reviewer - Behavioral Health Utilization Management Revi Job Brief responsible for completing medical necessity reviewsYour career starts now. We re looking for the next generation of health care leaders. At AmeriHealth Caritas, we re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we d like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at .Note to Applicants: The physical location of this teleworker position can be Shreveport or New Orleans, Louisiana. Responsibilities: Under the direction of the Supervisor, the Clinical Care Reviewer (CCR) is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the Clinical Care Reviewer s discretion to retain requests for additional information and/or request clarification. The CCR will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed. The incumbent applies medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The Clinical Care Reviewer will ensure that treatment delivered is appropriately utilized and meets the Member s needs in the least restrictive, least intrusive manner possible. The incumbent will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit s business and uses clinical judgment in their application. Education/Experience:Requires a graduate degree from an accredited educational program in Social Work, Clinical/Counseling Psychology, or NursingDemonstrated knowledge of plan benefit information and managed careRequires licensure for RN, LCSW, LSW, LPC, LMFT.Minimum three (3) years post graduate clinical experience or equivalent combination of education and clinically related work experienceMinimum one (1) year experience working with a managed care systemMinimum one (1) year experience in behavioral health service delivery systemKnowledge base in Medicaid, Medicare and commercial managed care systemsPC skills and experience utilizing Microsoft Office, Outlook, Excel and PowerPointAbility to provide constructive feedback with a focus on improved qualityAbility to communicate in a positive/professional manner both verbally and writtenAbility to work independently, complete multiple tasks in the allotted timeframeStrong problem solving skills and decision making skillsAbility to work effectively in a team environment Back Share Apply NowAssociated topics: addiction, advocate, behavioral, behavioral healthcare, coordinator, family, mental health, msw, npho, sickle
Keywords: Amerihealth, Baton Rouge , Clinical Care Reviewer - Behavioral Health Utilization Management Revi, Healthcare , Baton Rouge, Louisiana
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