Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information; assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.
Hours of operation for the Department: M- F 8:00am – 7:00pm.
This positon is 98% telephonic.
At least 3-5 years of experience in a Psychiatric Inpatient Setting or
3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience.
There will be rounds with a Doctor for 15 mins every day. Travel maybe required to a local hospital with a mileage rate of $0.54/mile.
Training will be 3 – 4 weeks long that will include Code of Conduct, Systems App and Shadowing.
Credentialing Paperwork will be completed during training.
Required License: LCSW, LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor Degree is required.
The Master Degree is required for all other licensing.
Kind Regards,
Kavita Kumari
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
DIRECT # - 732-844-8726
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.