Blue Cross and Blue Shield of Illinois, Montana, N Behavioral Health Care Coordinator in Richardson, Texas
We are the Health Care Management division of HCSC — a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.
We’re also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.
BASIC FUNCTION: 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.
Location: TX - Richardson
Activation Date: Thursday, April 8, 2021
Expiration Date: Saturday, May 1, 2021