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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.
THIS ROLE WILL TELECOMMUTE ON A FULL TIME BASIS WITHIN THE STATES OF NM, TX, OK, MT AND IL
Masters-level Behavioral Health Professionals: 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 Requirements:
- Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC) with current license to practice at the independent practice level.
- 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.
The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge, and experience. This role aligns with an Annual Incentive Bonus plan.
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Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.
We encourage people of all backgrounds and experiences to apply.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range: $58,800.00 - $130,100.00
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