About the role
Behavioral Health Clinical Reviewer (RN or Licensed Behavioral Health Professional)
Overview Health Care Service Corporation (HCSC) is seeking an experienced Behavioral Health Clinical Reviewer to evaluate behavioral health cases for medical necessity and appropriate levels of care. This role involves reviewing clinical documentation, assisting members by phone, and applying behavioral health criteria across the continuum of care. Candidates with behavioral health experience and managed care backgrounds are highly preferred.
Details
- Location: Chicago, IL (Cook County) – Must reside in or be willing to travel to Cook County
- Shift Time: Monday-Friday | 40 hours/week | 8-hour shifts
- Pay Rate: $42/hour with benefits
Responsibilities
- Review behavioral health cases for medical necessity and appropriateness of care
- Evaluate medical records and supporting clinical documentation
- Apply behavioral health criteria across outpatient, intensive outpatient, residential, and inpatient levels of care
- Assist members and providers via telephone regarding care coordination and authorization decisions
- Interpret behavioral health diagnoses and health plan benefits
- Document case reviews accurately and within required timelines
- Collaborate with internal and external healthcare professionals to support quality member outcomes
Required Qualifications
- Active, unrestricted Registered Nurse (RN) license OR Master's-level Behavioral Health Professional license eligible for independent practice
- Current clinical license in good standing
- Minimum 3 years of behavioral health or psychiatric clinical experience
- Strong verbal and written communication skills
- Excellent analytical and decision-making abilities
- Proficiency with computers, databases, and electronic documentation systems
- Behavioral Health experience required
- Managed Care experience preferred
Preferred Qualifications
- Utilization Review (UR) or Utilization Management (UM) experience
- Experience reviewing cases for medical necessity
- Health plan or managed care experience
- Knowledge of behavioral health treatment across multiple levels of care
- Experience working with behavioral health populations in a clinical review environment
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