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Utilization Review Social Worker Or RN
Las Vegas , NV 89148
Posted 2 months ago
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Utilization Review Social Worker(LISW/LCSW) or RN-Behavioral Health Managed Care
Las Vegas, NV
This is a Full-Time, Benefits Available, CONTRACT opportunity, expected to last several months, or longer! Utilization
Utilization Review Specialist Background:
- The Utilization Review Specialist is primarily a provider facing role, although it does involve some member activities such as collecting information and using clinical expertise to ensure members are directed to the appropriate level of care.
- Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
- Uses appropriate screening criteria, knowledge and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.
- Refers cases to Peer Reviewers as appropriate.
- Performs psychiatric and substance abuse or substance abuse disorder assessment, coordination, implementation, case planning, monitoring, and evaluating to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources.
- Requires a valid, unrestricted state as aLicensed Independent Social Worker (L.I.S.W) or Licensed Clinical Social Worker (L.C.S.W).
- Mental Health Professional required as defined by State: Master degree in social work, behavioral health or related field, and 2 additional years documented and supervised experience.
- Will consider Registered Nurses (R.N.) that have extensive behavioral health experience.
Around 3+ years of acute care clinical social work experience
- Previous 1-2 years of experience in utilization management / utilization reviewwith a broad range of experience with complex psychiatric/substance abuse cases preferred.
- Intermediate computer literacy (MS Office) and typing skills are necessary.