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Clinical Insurance Reviewer Lmhc Jobs in Riverside, CA

Astiva Health, Inc

UM Nurse Reviewer

Orange, CA · On-site

Apply clinical knowledge when processing deferrals and denials, supported by regulatory guidelines ... Dental Insurance * Health Insurance * Life Insurance * Vision Insurance * Paid Time Off ...

Astiva Health

UM Nurse Reviewer

Orange, CA · On-site

Apply clinical knowledge when processing deferrals and denials, supported by regulatory guidelines ... Dental Insurance * Health Insurance * Life Insurance * Vision Insurance * Paid Time Off ...

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All JobsClinical Insurance Reviewer Lmhc JobsClinical Insurance Reviewer Lmhc Jobs in Riverside, CA

Clinical Insurance Reviewer Lmhc information

What is a clinical insurance reviewer LMHC?

Clinical Insurance Reviewer LMHCs (Licensed Mental Health Counselors) are professionals who evaluate mental health treatment claims for insurance companies. They review clinical documentation to determine if the services provided meet medical necessity criteria and insurance policy guidelines. These reviewers ensure that treatment plans are appropriate, comply with regulations, and that claims are processed accurately. Their work helps balance quality patient care with insurance requirements, often serving as a liaison between providers, patients, and insurance representatives.

What are the key skills and qualifications needed to thrive as a clinical insurance reviewer LMHC?

To excel as a Clinical Insurance Reviewer (LMHC), you need a master's degree in mental health counseling, a valid LMHC license, and strong knowledge of clinical documentation and insurance regulations. Familiarity with utilization review software, electronic health records (EHRs), and payer-specific guidelines is typically required. Exceptional attention to detail, analytical thinking, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulatory standards, and efficient collaboration with providers and insurers.

What are some typical challenges faced by a clinical insurance reviewer LMHC, and how can they be managed?

A Clinical Insurance Reviewer LMHC often encounters challenges such as navigating complex insurance policies, meeting strict deadlines for case reviews, and balancing clinical best practices with insurance requirements. Managing these challenges involves staying up-to-date with evolving insurance regulations, maintaining strong organizational skills, and collaborating closely with both clinical teams and insurance representatives. Building clear communication channels and regularly updating documentation can also help streamline the review process and minimize misunderstandings.

What is the difference between Clinical Insurance Reviewer LMHC vs Mental Health Case Manager?

AspectClinical Insurance Reviewer LMHCMental Health Case Manager
CredentialsLMHC license, clinical training, insurance knowledgeOften licensed mental health professional, may also hold LMHC
Work EnvironmentInsurance companies, healthcare organizations, review settingsCommunity agencies, hospitals, outpatient clinics
Job FocusReviewing insurance claims, determining coverage, clinical assessmentCoordinating care, providing support, connecting clients to services

The Clinical Insurance Reviewer LMHC primarily evaluates insurance claims and coverage based on clinical assessments, working within insurance companies or healthcare organizations. In contrast, a Mental Health Case Manager focuses on coordinating client care and connecting individuals to mental health services. While both roles require mental health licensure, their daily tasks and work environments differ significantly.

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Clinical Insurance Reviewer Lmhc jobs near you

Licensed Clinical Social Worker

Riverside, CA • On-site

Riverside Family Physicians, A Pro
See more jobs at Riverside Family Physicians, A Proexternal

$35.34 - $53.56/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 17 days ago

Job description

Description

Position: Licensed Clinical Therapist LCSW and Licensed Marriage Family Therapist, LMFT

Reports To: Director of Behavioral Health

POSITION PURPOSE

Under the supervision of the LCSW Lead, the LCSW/LMFT plays a crucial role as part of the multidisciplinary team at Riverside Family Physicians. Responsibilities include assessments, treatments, psychotherapy, case management, and referrals for a diverse range of clients, including those with severe mental illness and adjustment issues. Services are delivered in accordance with professional ethics and boundaries.

Requirements


Major Responsibilities:

  • Conduct assessments, diagnosis, and treatment for patients using the DSM-5 TR, including initial mental status and psychosocial assessments.
  • Develop individual service plans, administer therapeutic treatments, and assist clients in developing appropriate behaviors.
  • Collaborate with interdisciplinary teams for support, interventions, discharge planning, and service coordination.
  • Consult with physicians, therapists, and medical professionals as needed.
  • Demonstrate proficiency in evidence-based practices and multicultural competence.
  • Screen patients for social determinants of health and provide case management services.
  • Carry a clinical caseload via telehealth or face-to-face sessions.
  • Provide supervision for non-licensed behavioral health staff as required.

Educational and Position Requirements:

  • LCSW, LMHC, or LMFT licensed by the state of California Board of Behavioral Science.
  • Master's Degree from an accredited school.
  • Background screening, valid California driver's license, and insurance.
  • American Heart Association Basic Life Support Provider certificate (CPR).

Knowledge, Skills, and Abilities:

  • Ability to follow directions, maintain records, and communicate effectively.
  • Initiative, judgment, discretion, and decision-making skills.
  • Knowledge of mental illness, symptomatology, psychotropic medications, and crisis intervention.
  • Dual diagnosis and substance abuse recognition.
  • Prioritization, independence, flexibility, and adaptability to change.
  • Proper documentation of clinical progress notes in the EHR.

Physical Demands and Work Environment:

  • Sitting, hand usage, reaching, talking, and occasional standing and walking.
  • Lifting up to 25 pounds and specific vision abilities.
  • Moderate noise level in the work environment.

Compensation & Benefits

Riverside Family Physicians offers a competitive compensation package commensurate with experience, including:


Compensation

  • Competitive salary with annual performance-based bonus opportunities
  • Total Compensation: $35.34/hr. - $53.56/hr.

Health & Wellness

  • Medical, dental, and vision insurance (employer-sponsored)

 Work-Life Balance 

  • Paid sick leave and paid holidays 
  • Supportive work-life balance through a team-based care model

Professional Development

  • Continuing Medical Education (CME) Leave - Five (5) paid days annually
  • CME Reimbursement - Up to $2,000 per year for professional dues and continuing education expenses

Licensing & Coverage

  • License renewal reimbursement
  • Professional Malpractice Insurance

Retirement & Financial Planning

  • 401(k) Safe Harbor Plan


Acknowledgements:
The job description may not cover all duties; incumbents will perform related duties as assigned by their supervisor.

Commitment to Team Culture:
The Riverside Family Physicians, APMC Team environment requires a Team Member to participate in the Riverside Family Physicians, APMC Team Culture.

A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.


Clinic Locations:
4244 Riverwalk Parkway, Ste. 150, Riverside, CA 92505
4310 Orange Street, Riverside, CA 92501


Phone: (951) 781-6335, Fax: (951) 781-6365


Job Type: Full-time


Work Location: In person

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