At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
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Job Summary
**THIS IS A TELECOMMUTER POSITION FOR THE 5 PLANS (TX, OK, NM, MT & IL) PLANS**
**Please note that you MUST be licensed to practice at the independent level for this role. The # of years of clinical experience required for this role is post licensure (# of years) at the independent practice level**
***THIS IS AN AFTER-HOURS ROLE. WORK HOURS ARE 8:30 AM TO 8:30 PM SATURDAY & SUNDAY***
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) 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 (post licensure at the independent practice level) 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.
#LI-Remote
Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.
We encourage people of all backgrounds and experiences to apply.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
