Remote Behavioral Health Utilization Clinician

Yoh Services LLC; Philadelphia (Philadelphia County); On-site; USD 44,000 - 62,000; Full time

Benefits offered by this job

Medical benefits

HSA

Life & Disability Insurance

401K

EAP

Direct Deposit

Referral Bonuses

Training opportunities

Job summary

Yoh Services LLC is seeking a Behavioral Health Clinician/Psych Nurse for a remote contract with a health insurance client located in Philadelphia, PA. The role reviews medical and treatment records to assess behavioral health needs and determine medical necessity, collaborating with providers to obtain information and authorizing services as appropriate.

Candidates must reside in the PA/NJ/DE tri-state area and hold an active PA licensed RN or LCSW/LMFT/LPC.

Qualifications

• Active PA licensed RN or LCSW/LMFT/LPC
• 3+ years Behavioral Health clinical experience
• Prior Behavioral Health utilization management experience desirable
• Medical management/precertification experience preferred
• Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe

Responsibilities

• Applies critical thinking and judgement to determine medical necessity using InterQual and policy resources
• Establishes need for inpatient and length of stay per criteria
• Contacts providers regarding treatment plans and clarifies medical need
• Reviews plans with provider for requested services and admissions
• Refers cases not meeting criteria to Medical Director for review
• Supports discharge planning and alternative settings when needed
• Reports utilization issues and offers improvement recommendations
• Ensures compliance with regulations and benefit coverage
• Documents all key functions per policy

Job description

Yoh Services LLC is seeking a Behavioral Health Clinician/Psych Nurse for a remote contract with a health insurance client located in Philadelphia, PA. The role reviews medical and treatment records to assess behavioral health needs and determine medical necessity, collaborating with providers to obtain information and authorizing services as appropriate.

Candidates must reside in the PA/NJ/DE tri-state area and hold an active PA licensed RN or LCSW/LMFT/LPC.