Share Email Opening Apply Now Title Utilization Review Clinician, Advocate  EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.   Description Utilization Review Clinician/Advocate needed for full-time, direct hire position working remotely. The social worker will: •Perform telephonic care review and authorization determinations for prospective, concurrent, and discharge review with psychiatric and substance use treatment facilities as assigned. •Determine appropriate level of care related to mental health and substance use treatment for members based on insurance medical necessity level of care criteria. • Consult with the treatment team when requests for services do not meet medical necessity criteria. •Interact with Physician Advisors to discuss clinical/authorization questions, alternative treatment options, and concerns regarding specific cases. •Provide information to members and providers regarding mental health and substance use benefits and community treatment resources.   Position Requirements LSW with a minimum of 5 years combined experience in direct care in behavioral health and/or substance abuse treatment settings and Utilization Review/ Care Management experience. Knowledge, Skills & Abilities: •Demonstrated experience establishing relationships and effectively engaging with insurance care managers and providers through telephonic communication to obtain the necessary information to obtain authorization for treatment in multiple settings. •Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes. •Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills. •Excellent communication skills, both verbal and written. •Demonstrated ability to relate effectively to behavioral health and medical treatment providers, members and family members, and other professionals involved in the member's treatment. •Familiarity with and ability to effectively utilize computer technology   This position is currently accepting applications. Apply Now

AppOne.comTM   copyright©1999-2021 HR Services, Inc. Click here for technical assistance.