Requisition Number: BOARD01543
- Utilizes independent judgement and experience to perform preauthorization behavioral health record review, including the application of medical necessity criteria and identification of potential quality of care concerns and renders accurate review determinations.
- Utilizes professional expertise to certify behavioral analysis services.
- Accurately enters data, clearly documenting the review determination and clinical information supporting it or creates a Second Level Referral if case cannot be certified. .
- Provides information and functions as a resource to provider staff and Call Center staff.
- Places incomplete cases in pending status for additional clinical information. Tracks and suspends cases as necessary.
- Attends staff meetings and continuing education sessions.
- Participates in Gold Standard test on hire and in quarterly inter-relater reliability assessments.
- Provides courteous and prompt service to all internal and external customers. Prioritizes and addresses requests and assignments in a professional manner to develop cooperative relationships and to ensure that customer confidentiality is assured