Administrative | Health & Mental Health
BHI is seeking a licensed behavioral health professional to join our 24/7 utilization management team working PRN to cover shifts as needed.
Working as part of an interdisciplinary team, the Utilization Reviewer is responsible for clinical review and authorization or recommendation for denial of services to members regarding the full continuum of care, including but not limited to psychiatric inpatient, sub-acute and specialty services. The Utilization Reviewer may participate in complex case reviews with multidisciplinary teams, disposition planning, coordination of benefits and care among providers and systems. This position is expected to consistently apply medical necessity criteria and decision support software when making utilization determinations. Provide documentation and recommendations to the Chief Medical Officer or appeal psychiatrist to determine appropriate levels of care. Applying and completing the processes for authorization letters and or notice of actions and appeal letters when appropriate.