Behavioral Health Clinical Reviewer (LCPC/LMSW)

w3r Consulting; Town of Texas (WI); Remote; USD 1,000; Full time

Job summary

A leading healthcare provider is seeking a Behavioral Health Clinical Reviewer. This role involves conducting clinical reviews to determine medical necessity, collaborating with teams, and ensuring adherence to guidelines. Ideal candidates will have a Master's degree and significant clinical experience.

Qualifications

• Minimum of 3 years clinical experience in psychiatric or behavioral health settings.

Responsibilities

• Conduct clinical reviews to assess medical necessity.
• Communicate with members and providers regarding behavioral health services.
• Document decisions and maintain accurate case records.

Skills

Communication

Analytical Skills

Decision-Making

Education

Master’s degree in a behavioral health field

Tools

Computers and Databases

Job description

Behavioral Health Clinical Reviewer (LCPC/LMSW)

This range is provided by w3r Consulting. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $40.00/hr

Direct message the job poster from w3r Consulting

Service Delivery Manager @ TalentRupt Inc. | Staffing Operations

Job Title: Behavioral Health Clinical Reviewer (LCPC/LMSW)

Location: Austin, TX (Remote candidates in Austin or San Antonio preferred, but open to Dallas/Fort Worth area & NM)

Contract Duration: 7 Months

Pay Rate: $40/hr

Job Summary:

The Behavioral Health Clinical Reviewer conducts clinical reviews of behavioral health cases to determine medical necessity. Responsibilities include communicating with members, reviewing medical records, interpreting behavioral health diagnoses within contractual guidelines, and applying established criteria to various levels of care, from outpatient to inpatient.

Key Responsibilities:

• Conduct clinical reviews to assess medical necessity.
• Communicate with members and providers regarding behavioral health services.
• Review and interpret medical records and clinical documentation.
• Apply evidence-based criteria and clinical guidelines to behavioral health services.
• Interpret behavioral health diagnoses in context of plan benefits and policies.
• Collaborate with internal teams for appropriate and timely care decisions.
• Document decisions and maintain accurate case records.

Required Qualifications:

• Experience in utilization review, case management, or managed care settings.
• Master’s degree in a behavioral health field (e.g., Social Work, Counseling, Psychology).
• Active, unrestricted clinical license (e.g., LCSW, LPC, LMFT).
• Minimum of 3 years clinical experience in psychiatric or behavioral health settings.
• Strong communication skills.
• Excellent analytical and decision-making skills.
• Proficiency with computers and databases.

Additional Details:

• Seniority level: Mid-Senior level
• Employment type: Contract
• Job function: Healthcare Provider
• Industries: Hospitals and Healthcare