KY – Telecommute
Pre-Authorization Behavioral Health Professional 2
Work at Home Kentucky
The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Location: Work at home Kentucky only
The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines, policies, and procedures to approve services or requests for the Medicaid Population. The Associate uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.
Complete pre-authorization reviews for facility based care.
Apply Medical Necessity Determination
Complete MD review process, if needed
Enter and maintain pertinent clinical information in various medical management systems.
Degree in Nursing or a Master’s degree in a Behavioral Health related field such as Social Work, Counseling, and/or Psychology, from an accredited university.
Applicable State licensure in field of study
Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license
Minimum of three (3) years of post-degree clinical experience in direct patient care
Three (3) years or more of Behavioral Health experience
Minimum of two (2) years of utilization management experience
Proficiency with Microsoft Office products
Experience working with computers
Experience with utilization review process
Knowledge of community health and social service agencies and additional community resources
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Scheduled Weekly Hours: 40
Bilingual , Social Work , Insurance , Medical & Health , Mental Health , Nursing