Utilization Review Clinician-BHC
About The Position
Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. TMH is the region's healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region's only Level II Trauma Center, Primary Stroke Center, Level III Neonatal Intensive Care, Pediatric Intensive Care, and the most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle. Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices. This role conducts ongoing pre-certification, concurrent, and retrospective reviews on the Tallahassee Memorial Behavioral Health Center (TMBHC) inpatient population. The clinician coordinates reviews with the respective insurance companies for which the medical necessity for initial admission certifications and continued stays are determined. This role also liaises between the Business Office, insurance companies, and attending psychiatrists.
Requirements
- Bachelor’s degree in a field of nursing, counseling, social work, psychology, or a related human services field
- Two (2) years of relevant job-related experience
Nice To Haves
- Current enrollment in a master’s degree program or master’s degree in a mental health specialty (e.g., Master of Social Work, Masters of Mental Health, Master of Mental Health Counseling, or Masters of Marriage and Family Therapy).
- Two (2) to five (5) years of relevant job-related experience
- Licensed as a registered nurse (RN) in accordance with Florida Statutes (F.S.), Title XXXII (Regulation of Professions and Occupations), Chapter 464 (Nursing), Part I (Nurse Practice Act) [includes multistate compact licensure] or licensed as a mental health professional (e.g., Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or Licensed Marriage and Family Therapist (LMFT)) in accordance with F.S., Title XXXII, Chapter 491 (Clinical, Counseling, and Psychotherapy Services)
Responsibilities
- Conducts ongoing pre-certification, concurrent, and retrospective reviews on the Tallahassee Memorial Behavioral Health Center (TMBHC) inpatient population.
- Coordinates reviews with the respective insurance companies for which the medical necessity for initial admission certifications and continued stays are determined.
- Liaises between the Business Office, insurance companies, and attending psychiatrists.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
