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Utilization Review Lcsw Jobs in Indiana (NOW HIRING)

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Utilization Review Lcsw information

What is the difference between Utilization Review Lcsw vs Medical Social Worker?

AspectUtilization Review LcswMedical Social Worker
CredentialsLicensed Clinical Social Worker (LCSW), certification in utilization review often preferredLicensed Clinical Social Worker (LCSW), with clinical social work experience in healthcare
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, patient homes, healthcare settings
Primary FocusReviewing medical necessity, insurance approvals, and utilization managementProviding psychosocial support, discharge planning, and patient advocacy

The Utilization Review Lcsw primarily focuses on insurance review and utilization management within healthcare settings, requiring knowledge of medical necessity criteria. In contrast, Medical Social Workers provide direct patient support, counseling, and discharge planning. While both roles require an LCSW license, their daily responsibilities and work environments differ significantly.

What are the key skills and qualifications needed to thrive as a utilization review LCSW?

To thrive as a Utilization Review LCSW, you need a master's degree in social work (MSW), LCSW licensure, and a strong understanding of clinical assessment and care coordination. Familiarity with medical necessity criteria, insurance guidelines, and electronic health record (EHR) systems is essential, and certification in case management or utilization review is often preferred. Exceptional analytical skills, attention to detail, and clear communication help you advocate effectively for patients and collaborate with healthcare teams. These competencies ensure appropriate care, cost-effectiveness, and compliance with regulatory standards in healthcare delivery.

What are the main challenges utilization review LCSWs face when balancing clinical judgment and insurance guidelines?

Utilization Review LCSWs often encounter the challenge of aligning their clinical assessments with insurance coverage criteria, which can sometimes restrict recommended care options. Navigating these situations requires strong communication skills to advocate for appropriate patient care while adhering to payer policies. Frequent collaboration with healthcare providers and insurance representatives is essential to ensure patients receive necessary services without unnecessary delays. This balancing act can be demanding but is also highly rewarding for those who value systemic impact and patient advocacy.

What is a utilization review LCSW?

A Utilization Review LCSW (Licensed Clinical Social Worker) is a mental health professional who evaluates the medical necessity, appropriateness, and efficiency of mental health services for patients. They review clinical documentation to ensure that treatments meet insurance and regulatory guidelines, often acting as a liaison between healthcare providers and payers. Their goal is to ensure patients receive necessary care while also reducing unnecessary costs and maintaining compliance with healthcare policies.

How to become a utilization review LCSW?

To become a utilization review LCSW, you must first earn a Master of Social Work (MSW) degree from an accredited program and obtain licensure as a Licensed Clinical Social Worker (LCSW) by meeting state-specific requirements, which typically include supervised clinical experience and passing a licensing exam. Additional training or certification in utilization review or healthcare management can enhance qualifications for this role.
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Utilization Review Lcsw jobs near you
Infographic showing various Utilization Review Lcsw job openings in Indiana as of August 2026, with employment types broken down into 79% Full Time, 13% Part Time, and 8% Contract. Highlights an 90% In-person, and 10% Remote job distribution.

Licensed Clinical Social Worker (LCSW)

Eventus WholeHealth

Goshen, IN • On-site

Full-time

Re-posted 24 days ago

Eventus WholeHealth rating

8.5

Company rating: 8.5 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Position Summary:
Eventus WholeHealth delivers an integrated model of care to adults who reside in skilled nursing and assisted living facilities through a network of healthcare providers including Physicians, Nurse Practitioners, Physician Assistants, Medical Assistants and in-house Support Staff.
We are seeking a Licensed Clinical Social Worker (LCSW) or a Licensed Independent Social Worker (LISW) to join our team! You will provide recovery-oriented rehabilitation services in group or individual settings. We care for individuals in long-term care settings, both skilled nursing and assisted living or personal care. We address a wide range of problems from anxiety and depression to severe and persistent mental illness to issues around death and dying. As part of a multidisciplinary team, our clinicians have the chance to make a big difference in the quality of life for these residents. We solve problems, deliver excellent clinical care, and provide a critical link in the care a vulnerable population.
Essential Duties and Responsibilities:
  • Assess each resident with a valid consent to determine individual needs. Develop and follow a treatment plan to meet each resident’s needs and ensure that all treatment provided is medically necessary.
  • Perform written or verbal consultation with clients' primary care physician, family, facility staff, and Eventus WholeHealth support staff as needed.
  • Document treatment plans, psychotherapy sessions, and treatment plan updates according to Eventus WholeHealth’s procedures and policies and provide the facility with written documentation within 48 hours of service for inclusion in the patient’s facility medical record.
  • Meet with Resident Care Coordinator or other staff as designated by the facility upon arrival to and departure from facility to review current facility care needs and communicate findings or concerns.
  • Establish and maintain open and positive communications with facility staff and administration. Provide verbal and/or written instruction or feedback regarding treatment plans and other pertinent caregiver information.
  • Be knowledgeable of and adhere to Eventus WholeHealth standards, policies, and procedures. Be aware of and adhere to all legal and regulatory agencies' rules and guidelines and professional ethical standards. Comply with all regulatory agencies governing health care delivery.
  • Conduct self in a professional manner at all times.
  • Maintain patient confidentiality at all times including appropriate use of cell phone, email, text messaging, patient records, and EMR. Agree to abide by and be knowledgeable of HIPAA rules and regulations.
  • Consult with the clinical supervisor when facing an unfamiliar resident, family, or facility request or recommendation regarding the care of a resident.
Qualifications/Education:
Psychologists—Doctoral degree from an accredited educational institution and a current license as a doctoral-level Psychologist and Health Services Provider issued by the state in which you will practice, required.
Licensed Clinical Social Workers—Master’s degree in social work, and a current license to practice in the state in which you will practice, required.
Knowledge:
  • Knowledge of assessment techniques, psychotherapy techniques, population–specific interventions, and delivering care following treatment plan.
  • Knowledge of how to use a variety of diagnostic tools and techniques, including the current edition of the DSM.
  • Knowledge of rules and regulations of bodies governing psychotherapy practice.
  • Knowledge of organization’s policies and procedures.
Skills Required:
  • Skill in gathering and analyzing physiological, socioeconomic, behavioral, and emotional patient data.
  • Skill in accurately evaluating patient problems and providing appropriate advice, intervention or referral.
  • Skill in written and verbal communication.
  • Skill in exercising a high degree of initiative, judgment and discretion.
  • Skill in establishing and maintaining effective working relationships.
Abilities:
  • Ability to react calmly and effectively in emergency situations.
  • Ability to work collaboratively with all members of the health care team.
  • Ability to make responsible decisions within the scope of a dependent medical practitioner.
  • Ability to evaluate and make recommendations for continuous quality improvement.
  • Ability to handle confidential and sensitive information.
About Eventus WholeHealth:
Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly-trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes. For more information, please visit www.eventuswholehealth.com.

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