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Behavioral Health Appeals Clinician
Behavioral Health Appeals ClinicianVirtualVocations • Huntington Beach, California, United States
Behavioral Health Appeals Clinician

Behavioral Health Appeals Clinician

VirtualVocations • Huntington Beach, California, United States
2 days ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Review Clinician Appeals - Behavioral Health.

Key Responsibilities

Performs clinical reviews to resolve and process appeals by analyzing medical records and clinical data

Ensures timely review and response to appeals in accordance with relevant standards

Communicates with members, providers, and other departments regarding appeals requests

Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

2 - 4 years of related experience

RN, LCSW, or LPC licensure required

Knowledge of NCQA, Medicare, and Medicaid regulations preferred

Knowledge of utilization management processes preferred

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Behavioral Health Clinician • Huntington Beach, California, United States