Offer summary

Qualifications:

Registered Nurse (RN) with current license or a Masters-level Behavioral Health Professional with independent practice license., 3 years of clinical experience in a psychiatric setting or own behavioral health practice., Strong verbal and written communication skills., Analytical and decision-making skills with PC and database experience..

Key responsabilities:

Conduct accurate and timely clinical reviews of behavioral health cases for medical necessity.

Assist members via telephone and review medical records and cases.

Interpret contracts related to behavioral health diagnoses and apply medical necessity criteria.

Manage various levels of behavioral health care from outpatient to acute inpatient settings.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute in-patient to out-patient office visits.

Job Requirements:

Registered Nurse (RN) with current license or Masters-level Behavioral Health Professional with current license to practice at the independent practice level. Current clinical license in state of operations and in good standings.
3 years clinical experience in psychiatric setting or own behavioral health practice.
Verbal and written communication skills.
Analytical and decision making skills.
PC and database experience.

Preferred Job Requirements:

Utilization review experience.

This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.