RN, Behavioral Health

This is a fully remote position, open to applicants in United States.

📋 Description

• Facilitate the telephonic coordination and delivery of clinical behavioral health services.

• Conduct prospective, concurrent, and retrospective evaluations of inpatient, outpatient, ambulatory, and ancillary services.

• Evaluate medical necessity, appropriate length of stay, intensity of service, and level of care.

• Review, research, and authorize requests for elective, direct, ancillary, urgent, and emergency services.

• Identify and suggest alternative treatments, service levels, and lengths of stay following approved clinical protocols.

• Analyze and prepare documentation for retrospective reviews and appeals in line with regulatory and accreditation standards.

• Establish, coordinate, and communicate discharge planning requirements.

• Investigate and resolve issues related to benefits, eligibility, non-authorized services, coordination of benefits, and care coordination.

• Create and provide targeted education for healthcare providers.

• Communicate with providers and other stakeholders to enhance care and treatment.

• Identify referral opportunities and advocate for quality and effective healthcare services and benefit utilization.

• Consult with both internal and external stakeholders on utilization and benefit management.

• Coordinate, document, and communicate all facets of the utilization/benefit management program.

⛳️ Requirements

• Valid and unrestricted Registered Nurse license is required.

• A minimum of 2 years of acute clinical experience as a Registered Nurse is required.

• At least 1 year of clinical experience in Behavioral Health.

• A minimum of 1 year of experience in Managed Care or Utilization Management.

• Preferred experience includes one year working in a health insurance plan or managed care setting.

• Certification in Case Management may be preferred based on the designated department assignment.

• Certification or progress towards certification is highly preferred and encouraged.

• Strong written and verbal communication skills are essential.

• Exceptional customer service and interpersonal skills are required.

• Proficient knowledge of Microsoft Office Suite PC applications is necessary.

• Ability to apply clinical criteria and guidelines for medical necessity, setting/level of care, and concurrent patient management.

• Understanding of standard medical procedures and practices, current trends in medicine and nursing, alternative care settings, and service levels.

• Familiarity with policies and procedures, member benefits, and community resources.

• Knowledge of applicable accreditation standards along with local, state, and federal regulations is important.

• Candidates may be required to undergo a pre-employment criminal background check.

🏝️ Benefits

• Full-time, permanent employment opportunity.

• Remote work environment available.

• Travel may be required based on company needs.

• Reasonable accommodations provided for individuals with disabilities.

• Equal opportunity employer dedicated to workforce diversity.