At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!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.
Responsibilities1. Provide accurate and timely review of clinical information provided verbally (telephonically) or written (for retrospective reviews). Utilize knowledge of all behavioral health diagnoses and related criteria (DSM-IV and/or ICD-10). 2. Assist members requesting behavioral health treatment services utilizing behavioral health medical necessity criteria. 3. Obtain and maintain knowledge of Medical Policy and its application for Predetermination, Medical Necessity and Appropriateness reviews. 4. Identify and address opportunities for quality improvement in all aspects of serving our customers. Assist in planning and implementation of system changes and procedures to achieve overall objectives in the corporate cost-containment program. 5. Communicate and interact effectively and professionally with co-workers, management, customers, etc. 6. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. 7. Maintain complete confidentiality of company business. 8. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. 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.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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