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RN - Behavioral Health and Utilization Management (003MV1)

Techlink Systems North Charleston ,SC
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Job Description:   Registered Nurse with Minimum 3 years’ experience in a related clinical setting.
Managed Care and Utilization Management experience required.
Behavioral Health Management experience required.

 

Duties: Under the direction of the Supervisor, the Clinical Care Reviewer (CCR) is responsible for completing medical necessity reviews.

Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review.
It is within the Clinical Care Reviewer’s discretion to retain requests for additional information and/or request clarification. The CCR will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed.  
The CCR will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when indicated.
CCRs are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible.

 

The CCR will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and uses clinical judgment in their application.

 

Company Description
TechLink Systems is a privately held IT Consulting Firm that provides Consulting Services to organizations nationwide. TechLink Systems is a certified MWOBE and has been in business since 1998. Our network spans all major U.S. metropolitan areas touched by major sectors such as entertainment and leisure, finance, industry and government, health sciences, and information technology. Whether you are a client seeking IT services and support or a candidate searching for new opportunities, TechLink System's outstanding customer service and dedication will exceed your expectations in the marketplace! TechLink has 6 regional offices located in San Francisco, Los Angeles, New York City, Philadelphia, Manila, and Bangalore.

http://www.techlinksystems.com/

Awards:
-Ranked Top 500 Asian-Owned & Asian Pacific American-Owned Businesses in the US -Ranked Top 100 Diversity-Owned & Privately-Owned Businesses in California -Ranked INC500 Fastest Growing Private Companies -Ranked Top 100 Largest Women Owned Business San Francisco Business Times -Ranked 50 Largest Minority-Owned Companies San Francisco Business Times - Ranked in Top 100 Woman Owned Business in the US, Diversity Business -Ranked in the Top 10 Minority-Owned Businesses in the Philadelphia Business Journal -Ranked in the Top 50 Woman-Owned Businesses in the 2014 Philadelphia Business Journal

Techlink Systems

Why Work Here?

We only choose the best partners from diverse backgrounds and different perspectives.

TechLink Systems is a privately held IT Consulting Firm that provides Consulting Services to organizations nationwide. TechLink Systems is a certified MWOBE and has been in business since 1998. Our network spans all major U.S. metropolitan areas touched by major sectors such as entertainment and leisure, finance, industry and government, health sciences, and information technology. Whether you are a client seeking IT services and support or a candidate searching for new opportunities, TechLink System's outstanding customer service and dedication will exceed your expectations in the marketplace! TechLink has 6 regional offices located in San Francisco, Los Angeles, New York City, Philadelphia, Manila, and Bangalore. http://www.techlinksystems.com/ Awards: -Ranked Top 500 Asian-Owned & Asian Pacific American-Owned Businesses in the US -Ranked Top 100 Diversity-Owned & Privately-Owned Businesses in California -Ranked INC500 Fastest Growing Private Companies -Ranked Top 100 Largest Women Owned Business San Francisco Business Times -Ranked 50 Largest Minority-Owned Companies San Francisco Business Times - Ranked in Top 100 Woman Owned Business in the US, Diversity Business -Ranked in the Top 10 Minority-Owned Businesses in the Philadelphia Business Journal -Ranked in the Top 50 Woman-Owned Businesses in the 2014 Philadelphia Business Journal

Address

North Charleston, SC
USA