Behavior Health- Licensed Social Worker
Company: ALLMED STAFFING INC
Posted on: June 5, 2021
1. Utilizing MCG, ASAM and State Specific guidelines to process
incoming behavioral health Outpatient services/procedures and Inpatient stay requests
to determine medical necessity and authorize units/days as
2. Making changes/corrections to
behavioral health Outpatient and Inpatient request as appropriate
when requested by the provider/facility
3. Communicate with the medical director, when appropriate. if
requests do not meet medical necessity guidelines.
4. Processing and documenting each review in the documentation
system (Aerial) utilizing appropriate templates and following
5. Attend team meetings
6. Participating in monthly peer chart audits
What software skills are needed? Word, Excel, Outlook. Need to be
detail oriented to ensure no spelling/grammar mistakes.
What are the hours? ( Training hours?) Monday-Friday 8am-5pm
Mountain Time Position is remote!
Will you be interviewing (Teams or phone) Yes, our clinical manager
will be interviewing over the phone.
Position Description: Collect case specific member information,
review and certify the medical necessity of prospective,
concurrent, and retrospective units of behavioral health inpatient
and outpatient services. Review each case and determine the most
appropriate services, the most appropriate setting in which the
services should be delivered, the most cost efficient methods for
delivery of care. Providing clinical and managed care expertise, as
well as Medical Director/physician consultation when appropriate.
Provide first level clinical review for all behavioral health
inpatient and outpatient services requiring authorization.
Evaluation for referral to Health Management. Answer telephone
calls promptly as scheduled and as needed. Demonstrate adequate
competence in computer software use in daily activities. Review
case-specific patient information concurrently for the medical
necessity of behavioral health hospital admissions using MCG, ASAM,
and State specific review criteria. The behavioral health reviewer
will assign the appropriate LOS days/ visits/ services in review of
the clinical information obtained. Document review using
appropriate note templates. Ensure timely notification of all
parties (telephonic and/or written), as necessary, regarding
certification determinations. Prepare case files for physician
review via Physician Consultant Services or Medical director. This
includes preparation of clinical information; correspondence.
Function as a member of a self-directed team to meet specific
individual and team performance metrics. Telephonic discussions
with health care providers to explain medical necessity
determinations and to obtain additional clinical information.
Ensure consistent application of the utilization review process for
all functional components. Document case review findings, actions,
and outcomes in accordance with policy. Participate in special
projects, as needed. Participate in team meetings. Manage workload
to ensure timely processing per URAC, NCQA, as well as state and
federal mandates. Other duties as assigned. Qualifications include:
Active behavioral health license or RN license; minimum of 3 year
clinical experience either in an inpatient or outpatient capacity.
Previous Utilization Management experience highly preferred. Sound
clinical judgment. Demonstrated understanding of managed care
concepts, Strong problem solving and decision making skills, Strong
departmental team player, Good written and verbal communication
skills, Personal computer skills, Strong time management and
prioritization skills, Excellent customer service skills including
a sense of urgency and ownership for resolving issues, Strong
interpersonal skills at an individual and team level, Ability to be
flexible, adjust quickly and react positively to change, Knowledge
of ICD-10 and CPT coding preferred. Positive attitude and good work
Allmed is a National Staffing and Recruiting company offering
short and long term staffing solutions. We have supplied staffing
solutions for providers and managed care organizations throughout
the United States since 2003. We work with public and private firms
seeking innovative, effective solutions for short and long term
staffing strategies that works specifically for them.
Keywords: ALLMED STAFFING INC, Cheyenne , Behavior Health- Licensed Social Worker, Other , Cheyenne, Wyoming
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