Louisiana Licensed Behavioral Health Reviewer

Conducting clinical reviews of behavioral health service requests, the full-time Louisiana Licensed Behavioral Health Reviewer will assess medical necessity and appropriateness of care while collaborating with the Behavioral Health Medical Director and communicating decisions to providers and members in a remote setting. Key responsibilities Review pre-authorization requests, concurrent reviews, and retrospective claims for behavioral health services Apply clinical guidelines to document medical necessity and refer complex cases for secondary review Communicate determinations to providers and members through phone and written correspondence Required qualifications Bachelor's degree in nursing, healthcare, or a related field OR master's degree in social work, counseling, or behavioral health RN license in Louisiana or LPN license in Louisiana with 2 years of related experience At least 3 years of clinical or patient care experience in behavioral health Must hold one of the following licenses: LPC, PLPC, LCSW, LMFT, LMSW, LPN, or RN Strong clinical assessment and critical thinking skills