Requirements
Clinical Reviewers will conduct telephonic and document based utilization reviews that adhere to state directed clinical criteria for determining medical need.
Education & Experience Requirements: A Minimum of a TN Licensed Practical Nurse with a minimum of three years psychiatric and/or geriatric experience. Preferably both.
Additional Requirements:
§ Understands diverse cultures and gender specific issues and has the ability to incorporate needs of gender and culturally diverse groups into utilization review decisions.
§ Possesses high level of language skills including the ability to professionally and collegially communicate (both written and verbally) with other professionals. This also includes having the ability to read and interpret general medical and mental health summaries and be able to write case summaries which focus on the support needs of the target population.
§ Has a very high reasoning ability which includes the ability to define problems, collect data, establish facts and draw valid conclusions.
§ Possesses moderate computer skills with word processing software, spreadsheets and internet software. In addition, must have the ability to learn customize software.
§ Excellent organizational skills, including strong multi-tasking skills with the ability to prioritize and work independently.
§ Moderate knowledge of DSM and/or ICD-9 criteria, pharmacologic and/or psychotropic medications and medical diagnoses, as appropriate for contract review population and requirements.
Quality Coordinators will review clinical assessments conducted by field contract staff and perform both written and verbal feedback regarding quality, timeliness, and completeness of assessments.
Education & Experience Requirements: Preferably a MS with a minimum of 2 years experience in a behavioral health related field working with individuals with mental illness. A BS may be accepted with a minimum of 3 years in a behavioral health related field working with individuals with mental illness.
Additional Requirements:
· Excellent communication skills, both written and telephonic.
· Excellent organizational skills, including strong multi-tasking skills, ability to prioritize workload and work independently.
· Ability to demonstrate understanding of treatment models for target populations (i.e., behavioral health utilization review positions must have strong insight into a variety of models and theories of mental illness, and related issues, as well knowledge of philosophies, practices, policies and outcomes of models of treatment, recovery, relapse prevention, and continuing care);
· Understanding of diagnostic criteria for target populations and ability to conceptualize modalities and placement criteria within a continuum of care.
· Understanding of diverse cultures and gender specific issues and ability to incorporate needs of gender and culturally diverse groups into utilization review decisions.
If you feel you meet our requirements, we would love to hear from you. Please submit a resume and cover letter to mstokes@ascendami.com
Include your salary requirements on your cover letter.
EEO Employer
