Managing psychiatric and substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review
Assessing member needs to ensure access to medically necessary quality behavioral healthcare
Referring cases to Peer Reviewers as appropriate
Performing psychiatric and substance abuse disorder assessment coordination, implementation, case planning, monitoring and evaluating to promote quality member outcomes
Requirements
Requires MA/MS in social work, counseling, or a related behavioral health field, or a degree in nursing
Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
Current active unrestricted license (RN, LCSW, LMSW, LMHC, LPC, LBA, LMFT, Clinical Psychologist) to practice as a health professional
Proficient in Microsoft Office Suite (Word and Outlook) preferred
Previous experience in utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred
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