managing psychiatric and substance abuse disorder facility-based and outpatient professional treatment health benefits through live telephonic or written review
assesses member needs to ensure access to medically necessary behavioral healthcare in a cost-effective setting
refers cases to Peer Reviewers as appropriate
performs psychiatric and substance abuse disorder assessment coordination implementation case planning monitoring and evaluating
assists with more complex cases and may participate in inter and intradepartmental teams projects and initiatives
Requirements
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 treatment
current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA LMFT or Clinical Psychologist
previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required
prior managed care experience required
expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
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