Clinical Reviewer

GeBBS Consulting; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

GeBBS Consulting is seeking a Behavioral Health UM Specialist to support utilization management reviews for mental health services, including Partial Hospitalization Programs and Intensive Outpatient Programs. The role reviews patient information against guidelines, handles about 25 cases per day, and communicates with providers for needed information while applying UM criteria.

Training will be provided for 1–2 weeks.

Qualifications

• Must be licensed in DC, MD, or VA as LCSW/LPC/LCPC.
• 5+ years of clinical experience.
• Some prior-authorization or utilization management experience.
• Substance health or mental health background.
• Experience with MCG, Apollo, or ASAM/FEP guidelines.

Responsibilities

• Review mental health cases for PHP/IOP utilization.
• Assess clinical information against guidelines.
• Manage ~25 cases per day and communicate with providers.
• Use UM systems and criteria like MCG, Apollo, and ASAM/FEP.
• Ensure services are appropriately authorized per policies.

Skills

Utilization management

Mental health

Provider communication

Clinical documentation

Education

Licensed in DC, MD, or VA (LCSW/LPC/LCPC)

Tools

GuidingCare

MCG

Apollo

ASAM/FEP guidelines

Job description

GeBBS Consulting is a healthcare technology professional services and consulting firm based in Towson, Maryland servicing clients throughout the US. We are celebrating our 28th year in business. We have two divisions: 1) Hospital / Provider Practice 2) Managed Care / Payer Practice – we work directly with health plans (very strong in the Blue Cross Blue Shield space). GeBBS Consulting has over two decades of experience supporting healthcare clients throughout the US.

Summary:

We are looking for a Behavioral Health UM Specialist to support utilization management reviews for mental health services, particularly Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP). The hired resource will review patient clinical information against guidelines, handle approximately 25 cases per day, communicate with providers for additional information or clarification, and utilize UM systems and criteria such as MCG, Apollo, and ASAM/FEP to ensure services are appropriately authorized in line with the organization’s policies and clinical standards.

Training will be provided for 1-2 weeks. Regular schedule is from 08:00 or 08:30 AM for a full 8-hour shift.

Need to Close:

• Must be licensed (LCSW, LPC or LCPC) in DC, MD, or VA states
• 5+ years of overall clinical experience
• Some prior-authorization or utilization management experience
• Substance health or mental health background
• Experience with MCG, Apollo, or ASAM/FEP guidelines

Nice to have:

• Experience with GuidingCare

Recruiting Fraud

Over the past year, online recruitment scams have increased frequently, impacting both applicants and employers. To help protect yourself against potential scammers, please note the following recruitment practices employed by GeBBS Consulting.

• GeBBS Consulting uses a single domain name for all recruiting activities and all Authorized GeBBS Consulting Recruiters use the same domain name for all email correspondences. The official GeBBS Consulting domain is gebbsconsulting.com. If you receive emails or are directed to an email other than GeBBSConsulting.com, you are not responding to GeBBS Consulting.
• GeBBS Consulting screens applicants through a combination of over-the-phone, video and in-person meetings.
• GeBBS Consulting will never ask a candidate for payment of any kind as part of the hiring or onboarding process.