Work Location: This is remote, in Texas. Manager prefers candidates near Austin or San Antonio , but open to Dallas/Fort Worth area. The manager is also open to candidates in NM if necessary
Contract: 2025-09-04 to 2025-12-31
Description:
The position is 100% on a clinical queue. It is staffed only with behavioral health clinicians because they are making clinical decisions to approve treatment requests or send for peer review doc to doc review. The clinicians take incoming calls from providers asking for authorization. There are times a member in crisis is routed to the queue and the clinician will assist the member through their crisis at that time.
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.
JOB REQUIREMENTS:
PREFERRED JOB REQUIREMENTS:
...Our Team is helping a great Law Firm find a Marketing and Communications Specialist. Must have 4+ years of marketing and communications experience... ...all award, rankings, recognition and more Role is remote but must be close to Northern Virginia in case being in...
...goals: Promote timely access to appropriate care; increase utilization of preventative care; reduce emergency room utilization and hospital readmissions; create and promote adherence to a care plan developed in coordination with the patient, primary care provider, and...
...rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking an experienced Producer for their Alpharetta location. This position is responsible for promoting and executing on the sale of new and renewal business,...
...system. Demonstrate expertise in production purchase orders, sales purchase orders, EDI, inventory management, invoicing, and key... ...documentation discrepancies. Troubleshoot packing challenges and generate labels as needed. Maintain clear communication between...
...just expected it is celebrated. With a reputation for exquisite food and the highest standards of culinary artistry, wine expertise,... ...service excellence Ability to multitask and remain composed in a fast-paced environment Strong communication and teamwork skills...