Title: Behavioral Health Clinical Reviewer- (LADC/BCBA Certification)

Location: Eagan, MN 100% Remote

Duration: 6 months (Possible CTH)

3 Openings (2 for BCBA and 1 for LADC)

JOB DESCRIPTION:

ATTENTION: 1. Job - This requisition is for the Board-Certified Behavioral Analyst (BCBA) 2 Openings

2. Job - This requisition is for the Licensed Alcohol and Drug Counselor (LADC) 1 Openings

Required Skills and Experiences:

• Registered nurse or licensed behavioral health clinician (i.e. LICSW, LPCC, LMFT, LP, LADC) with current MN license and no restrictions or pending restrictions.
• 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
• Certification in utilization management or a related field.
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• 3 years of related, progressive clinical experience (i.e. RN or LPN to RN mix).
• Demonstrated ability to research, analyze, problem solve and resolve complex issues.
• Demonstrated strong organizational skills with ability to manage priorities and change.
• Proficient in multiple PC based software applications and systems. Demonstrated ability to work independently and in a team environment.
• Adaptable and flexible with the ability to meet deadlines.
• Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility, and appropriateness of treatment conditions. Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and member contracts in order to ensure compliance.
• High school diploma (or equivalency) and legal authorization to work in the U.S

Preferred Skills and Experiences:

• 5 years of RN or relevant clinical experience.
• 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
• Certification in utilization management or a related field.
• Experience in UM/CM/QA/Managed Care.
• Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
• Coding experience (e.g. ICD-10, HCPCS, and CPT).