USA - The Utilization Review Clinician is responsible for the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Responds to requests for services and interfaces with managed care organizations, external reviewers and other payers. Assures good customer service practices are utilized. Maintains denials and appeals logs and reviews the progress of all appeals activity. Qualifications Experience/Education : Graduate from an accredited program of professional nursing, social work, mental health, behavioral sciences or related field required. Bachelor's degree is preferred. A minimum of five (5) years direct clinical experience in a psychiatric setting or mental health treatment setting required. Experience in patient assessment, family motivation, treatment planning and communication with external review organization or comparable entities. Licensure: R.N., L.P.C.C., L..S.W. or applicable license, Ad - Permanent - Full-time
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