Clinical Care Reviewer II - Multi State License - RN - Behavioral Health

Job Summary:Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members.Essential Functions:Complete prospective, concurrent and retrospective review of Behavioral Health servicesIdentify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of careEngage with medical director when additional clinical expertise if neededMaintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standardsIdentify and refer quality issues to Quality ImprovementIdentify and refer appropriate members for Care ManagementProvide guidance to non-clinical staffProvide guidance and support to LPN staffAttend medical advisement and State Hearing meetings, as requestedAssist Team Leader with special projects or research, as requestedPerform any other job related duties as requested.Education and Experience:Associates of Science (A.S) in Nursing required orBachelor of Science (B.S) in Social Work requiredThree (3) years clinical experience requiredUtilization Management/Utilization Review experience preferredMedicaid/Medicare/Commercial experience preferredCompetencies, Knowledge and Skills:Proficient data entry skills and ability to navigate clinical platforms successfullyWorking knowledge of Microsoft Outlook, Word, and ExcelEffective oral and written communication skillsAbility to work independently and within a team environmentAttention to detailProper grammar usage and phone etiquetteTime management and prioritization skillsCustomer service orientedDecision making/problem solving skillsStrong organizational skillsChange resiliencyLicensure and Certification:Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) requiredMCG Certification is required or must be obtained within six (6) months of hire requiredWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeTravel is not typically requiredCompensation Range:$62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary):HourlyOrganization Level Competencies Fostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1

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