Behavioral Health Utilization Review Nurse

VIVA USA Inc; Chicago (IL); On-site; USD 70,000 - 100,000; Full time

Job summary

VIVA USA Inc. is seeking a clinician to perform timely and accurate clinical reviews of behavioral health cases for medical necessity, from outpatient visits to acute inpatient care. You will assist members by phone, review records, and interpret contracts while applying medical necessity criteria.

The role requires an active clinical license (RN or Masters-level BH professional) and at least 3 years of psychiatric care experience. Strong communication and analytical skills are essential.

Qualifications

• Must hold an active clinical license in the state of operation or an equivalent independent practice license.
• Minimum 3 years of clinical experience in a psychiatric setting or behavioral health practice.
• Strong verbal and written communication skills and analytical decision-making abilities.

Responsibilities

• Conduct timely and accurate clinical reviews of behavioral health cases for medical necessity across levels of care.
• Assist members by phone and review medical records and contract interpretations.
• Apply knowledge of medical necessity criteria for outpatient to inpatient behavioral health care.

Skills

Verbal and written communication

Analytical decision making

PC and database experience

Education

Registered Nurse license (RN)

Masters-level Behavioral Health Professional license

Job description

VIVA USA Inc. is seeking a clinician to perform timely and accurate clinical reviews of behavioral health cases for medical necessity, from outpatient visits to acute inpatient care. You will assist members by phone, review records, and interpret contracts while applying medical necessity criteria.

The role requires an active clinical license (RN or Masters-level BH professional) and at least 3 years of psychiatric care experience. Strong communication and analytical skills are essential.