AltaStaff is a staffing agency currently looking for a Behavioral Health Care Review Clinician I to work with our Managed Care Client!Pay Rate: $40 - $43 hourlyAvailable Schedules: Monday- Friday 8:00-5:00pm EST, potential for overtime with an expectation to cover weekends if necessary***This is a fully remote role but candidates must reside in Florida and must have LCSW, LMHC, LMFT or RN License in FL***Summary: This role will review provider service requests for applicable medical necessity and processing results. Will assesses outpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Works to ensure patient progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.Responsibilities:Completes/reviews Outpatient Authorizations, reviewing faxes that can be 50-100 pages longAnalyzes clinical service requests from members or providers against evidence based clinical guidelines.Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.Conducts outpatient reviews to determine financial responsibility for the client and its members. May also perform prior authorization reviews and/or related duties as needed.Processes requests within required timelines.Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.Requests additional information from members or providers in consistent and efficient manner.Makes appropriate referrals to other clinical programs.Collaborates with multidisciplinary teams to promote Care Model.Adheres to UM policies and procedures.POSITION QUALIFICATIONSMust have LCSW, LMHC, LMFT or RN License in FLMust have 2+ years of clinical practice experience (behavioral health, hospital, case management, utilization management)Must have 1-2+ years Utilization Management experienceMust have 2+ years of recent direct care experience in Behavioral Health including: Psychosocial Rehabilitation, Day Treatment, Partial Hospitalization Program, Intensive Outpatient Program, Mental Health Targeted Case Management, Residential Treatment.Knowledge of Florida Agency for Healthcare Administration (AHCA) BH coverage policiesMust have experience working in a high production capacityWork Environment Requirements:Must be able to to lift at least 30lbsMust be able to stand or sit for prolonged periods (75% of the time)Private Secured Internet ConnectionMust confirm work environment is safe and secure for work in handling private and sensitive information.Constantly operates a computer and other office equipmentConstantly works indoors in a secluded safe spaceMust have High-speed internet access 25 MBPS minimum; 50 MBPS minimum preferredIf you've applied and would like to view your application status, please visit:AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.#INDHP#ZR
