UTILIZATION REVIEW CLINICIAN (Clinical License Required) in Cypress, CA at Beacon Health Options

Date Posted: 6/18/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic UTILIZATION REVIEW CLINICIAN to join our team at our office in Cypress, CA.  The UTILIZATION REVIEW CLINICIAN will evaluate clinical information to screen for medical necessity and service appropriateness under the Orange County Mental Health Plan. S/he will be completing telephonic screenings to determine beneficiary needs, risks and performing ongoing utilization review for continued treatment.

Position Responsibilities:

  • Authorizes outpatient behavioral health treatment according to clinical information provided and criteria for medical necessity and appropriateness of care

  • Proposes alternative treatment when treatment requests do not meet medical necessity criteria

  • Analyzes specific utilization problems, and plans and implements solutions that directly influence quality of care and financial liability

  • Interacts with physicians and members of the provider clinical team for authorization decisions

  • Provides information to beneficiaries and providers regarding mental health and substance use disorder benefits and community treatment resources

  • Interacts with supervisory staff and County staff to discuss clinical authorization questions and concerns regarding specific treatment requests

  • Interacts with providers and facilities in a professional, respectful manner that facilitates the treatment process

  • Complies with the ASO’s standards for documentation of clinical information, clinical contacts, and care authorization

  • Other duties as assigned

 Position Requirements:

Education: Master’s degree or higher in a health related field and licensure as a behavioral health professional

Licensure:  Must have a current, valid, unrestricted licensed behavioral health clinician/nurse (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.)

Relevant Work Experience:   A minimum of 3 - 5 years of combined behavioral health clinical and managed care experience.

Knowledge, Skills & Abilities:

  • Knowledge of current behavioral health principles, procedures, and treatment protocols

  • Strong interpersonal skills and good written and verbal communication skills

  • Strong interpersonal skills and good written and verbal communication skills.

  • Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint

  • Bilingual Preferred

HOURS - MWF 9:30-6 and TR 7:45-4:15 

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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