Behavioral Health Clinical Reviewer- (LADC/BCBA Certification)
Posted 1 week ago by 1753343530
Negotiable
Outside
Remote
USA
Summary: The Behavioral Health Clinical Reviewer position requires candidates with LADC or BCBA certification to conduct clinical reviews in a remote setting. The role involves evaluating managed care cases, ensuring compliance with regulations, and utilizing strong analytical and organizational skills. There are three openings available, with two for BCBA and one for LADC, and the position is expected to last for six months with a possibility of conversion to a full-time role. Candidates must possess relevant clinical experience and a current Minnesota license.
Key Responsibilities:
- Conduct clinical reviews for managed care cases.
- Ensure compliance with state and federal regulations and accreditation standards.
- Analyze and resolve complex issues related to coverage, eligibility, and treatment appropriateness.
- Utilize strong organizational skills to manage priorities and deadlines.
- Work independently and collaboratively within a team environment.
Key Skills:
- Current MN license as a registered nurse or licensed behavioral health clinician (e.g., LICSW, LPCC, LMFT, LP, LADC).
- 1+ years of managed care experience (case management, utilization management, auditing).
- Certification in utilization management or a related field.
- 3 years of related clinical experience.
- Strong analytical and problem-solving abilities.
- Proficiency in PC-based software applications.
- Adaptability and flexibility in meeting deadlines.
- High school diploma or equivalent and legal authorization to work in the U.S.
Salary (Rate): undetermined
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Other
Title: Behavioral Health Clinical Reviewer- (LADC/BCBA Certification)
Location: Eagan, MN 100% Remote
Duration: 6 months (Possible CTH)
3 Openings (2 for BCBA and 1 for LADC)
JOB DESCRIPTION:
ATTENTION: 1. Job - This requisition is for the Board-Certified Behavioral Analyst (BCBA) 2 Openings
2. Job - This requisition is for the Licensed Alcohol and Drug Counselor (LADC) 1 Openings
Required Skills and Experiences:
- Registered nurse or licensed behavioral health clinician (i.e. LICSW, LPCC, LMFT, LP, LADC) with current MN license and no restrictions or pending restrictions.
- 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
- Certification in utilization management or a related field.
- All relevant experience including work, education, transferable skills, and military experience will be considered.
- 3 years of related, progressive clinical experience (i.e. RN or LPN to RN mix).
- Demonstrated ability to research, analyze, problem solve and resolve complex issues.
- Demonstrated strong organizational skills with ability to manage priorities and change.
- Proficient in multiple PC based software applications and systems. Demonstrated ability to work independently and in a team environment.
- Adaptable and flexible with the ability to meet deadlines.
- Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility, and appropriateness of treatment conditions. Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and member contracts in order to ensure compliance.
- High school diploma (or equivalency) and legal authorization to work in the U.S
Preferred Skills and Experiences:
- 5 years of RN or relevant clinical experience.
- 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
- Certification in utilization management or a related field.
- Experience in UM/CM/QA/Managed Care.
- Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
- Coding experience (e.g. ICD-10, HCPCS, and CPT).