Behavioral Health Care Navigator II

eBSI Export Academy; United States; Remote; USD 41,000 - 66,000; Full time

Job summary

CareSource is seeking a Clinical Care Reviewer II – Behavioral Health to process medical necessity reviews for behavioral health services. The role supports discharge planning, care coordination, and collaboration with care partners across transitions in care.

Requires RN or social work licensure, 3+ years of clinical experience, and MCg certification within 6 months. Knowledge of state/federal regulations and utilization review is preferred.

Qualifications

• RN licensure (unrestricted) required
• LSW/LCSW/LICSW/ACSW/LMHC/LPC/LMFT/LMHP licensure required
• MCG Certification required or within 6 months of hire
• Minimum 3 years clinical experience
• Utilization Management/Utilization Review experience preferred
• Medicaid/Medicare/Commercial experience preferred

Responsibilities

• Prospective, concurrent and retrospective review of Behavioral Health services
• Coordinate care with collaborative care partners for transition to appropriate level of care
• Engage medical director when clinical expertise is needed
• Maintain knowledge of state and federal regulations and contracts
• Identify and refer quality issues to Quality Improvement
• Direct care management referrals as appropriate
• Provide guidance to non-clinical staff and to LPN staff
• Attend medical advisement and State Hearing meetings as requested
• Assist Team Leader with special projects or research
• Perform other job-related duties as requested

Skills

Data entry

Microsoft Outlook

Microsoft Word

Microsoft Excel

Communication skills

Independent worker

Time management

Customer service

Decision making

Organizational skills

Change resiliency

Education

AS in Nursing

BS in Social Work

MS in mental health field

Tools

Clinical platforms

Job description

CareSource is seeking a Clinical Care Reviewer II – Behavioral Health to process medical necessity reviews for behavioral health services. The role supports discharge planning, care coordination, and collaboration with care partners across transitions in care.

Requires RN or social work licensure, 3+ years of clinical experience, and MCg certification within 6 months. Knowledge of state/federal regulations and utilization review is preferred.