- Location: Austin, Texas
- Type: Contract
- Job #102720
Job Title: Behavioral Health Clinical Reviewer (RN or Licensed BH Professional)
Location: Remote, United States
Job Type: W2 Contract
Expected Hours per Week: 40 hours per week
Schedule: Monday-Friday, standard business hours
Pay Range: $41.50 per hour
Position Description: We are seeking a Behavioral Health Clinical Reviewer to ensure accurate and timely clinical review of behavioral health cases for medical necessity.
This role combines
clinical review and case management responsibilities, including reviewing medical records, assisting members via phone, coordinating care, and interpreting contract language related to behavioral health diagnoses. The ideal candidate will have strong experience across the continuum of care and a background in
case management within behavioral health settings.
What You'll Do: - Conduct clinical reviews of behavioral health cases for medical necessity.
- Review and evaluate medical records to determine appropriate levels of care.
- Perform case management activities including care coordination, discharge planning, and provider collaboration.
- Assist members via telephone with behavioral health-related needs and care navigation.
- Interpret contract language related to behavioral health diagnoses and services.
- Apply medical necessity criteria across outpatient, intermediate, and inpatient levels of care.
- Ensure timely, accurate clinical determinations and documentation.
Skills Required: - Strong analytical and decision-making skills.
- Registered Nurse (RN) with active, current license.
- Excellent verbal and written communication skills.
- Case management and care coordination experience.
- Proficiency with PC systems and databases.
Skills Preferred: - Utilization Review (UR) experience.
- Managed care or payer-side experience.
Experience Required: - Minimum 3 years of clinical experience in a psychiatric or behavioral health setting.
- Hands-on case management experience within behavioral health.
Even Better, You May Have: - Experience working in utilization management or clinical review environments.
- Familiarity with discharge planning and care coordination workflows.
Experience Preferred: - Utilization review or managed care experience.
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