at Health Care Service Corporation in Chicago, Illinois, United States
Job Description
**THIS IS A TELECOMMUTER ROLE FOR OUR ALBUQUERQUE, CHICAGO, RICHARDSON AND TULSA HEADQUARTERS**
**Position is Part-Time, Exempt status – 32 hours/week, with evenings and weekends schedule**
**Work Hours every week are: one 8 hour shift on Friday nights from 12:30 am-8:30 am (Saturday morning) and two 12-hour shift from 8:30 pm - 8:30 am on Saturday and Sunday nights**.
*MUST HAVE: At least 3 years clinical experience post licensure at the independent practice level in psychiatric setting/outpatient facility, or own behavioral health practice.*
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:
*Registered Nurse (RN) with current license or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, RPsy) with current license to practice at the independent practice level.
*Current clinical license in state of operations and in good standings.
*3 years clinical experience in psychiatric setting or own behavioral health practice.
*Verbal and written communication skills.
*Analytical and decision making skills.
*PC and database experience.
PREFERRED JOB REQUIREMENTS:
* Utilization review experience.
Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.
BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
