Job Description

Job Description

Job Description

Hiring Requirements

RN with 3 years of clinical experience or LPN with 5 years of clinical experience.

For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.

Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

Top 3-4 Required Skills:

RN with substance abuse

Multi system capability

working knowledge of outlook

Managed care experience

Nice to have Skills:

Social worker

Years of Experience:

3-5 years of experience.

If they have not done managed care they need more years of experience

Education/Certifications Required:

Licensed behavior health provider

Industry Specific Experience – required, ideal, necessary?

Case manager experience

Clinical Evaluation and Review

Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME)

Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations.

Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards

Provide notifications to member and/or provider, according to regulatory requirements.

Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.

May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelinesCollaboration and Documentation

Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work

Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information

Utilize detailed clinical knowledge to summarize clinical review against the criteria/guidelines to provide necessary information for MDs.

Company Description

Select Source International (SSI) is a distinguished staffing company with nearly 25 years of experience, renowned for delivering top-tier workforce solutions encompassing staffing, recruiting, and managed services. As a proud supplier, we bring a wealth of expertise and best-in-business differentiators to comprehensively support your diverse workforce needs.

Based in Minneapolis, Minnesota, USA, SSI has established itself as a global leader, serving a broad clientele across industries with unwavering dedication and excellence. SSI is ISO 9001, 14001, and Soc2 Type2 certified, underscoring our commitment to quality and security. We have garnered numerous sustainability and supplier diversity awards, further validating our industry-leading capabilities

Company Description

Select Source International (SSI) is a distinguished staffing company with nearly 25 years of experience, renowned for delivering top-tier workforce solutions encompassing staffing, recruiting, and managed services. As a proud supplier, we bring a wealth of expertise and best-in-business differentiators to comprehensively support your diverse workforce needs.\r\n\r\nBased in Minneapolis, Minnesota, USA, SSI has established itself as a global leader, serving a broad clientele across industries with unwavering dedication and excellence. SSI is ISO 9001, 14001, and Soc2 Type2 certified, underscoring our commitment to quality and security. We have garnered numerous sustainability and supplier diversity awards, further validating our industry-leading capabilities

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