November 15, 2021
Job Type
Work Setting
Remote / Home-based


Perform document-based and telephonic utilization review for contracted services; screening for diagnosis or suspicion of serious mental illness and or intellectual disability, and medical necessity for short or long-term nursing facility placement.

Candidates must hold one of the following licenses in Louisiana:

  • LPC: Licensed Professional Counselor
  • LMFT: Licensed Marriage and Family Therapist
  • LMSW: Licensed Master Social Worker
  • LCSW: Licensed Clinical Social Worker
  • Plus a minimum of 2 years of experience in mental health diagnosis and assessment.

Job Summary

Essential Duties and Responsibilities:

- Responsible for pre-admission and concurrent reviews for admissions and continued placement in Medicaid certified nursing facilities, utilizing federal and State’s criteria

- Review and communicate all information with providers, utilizing a computer database system for determining nursing facility placement appropriateness

- Utilize both referral screens and medical records review to make determinations

- Develop and document a clinical rationale supporting the review decision as to the final step in the review process.  Must work within a tight turnaround time assuring contract compliance

- Complete other job duties as assigned or necessary

Minimum Requirements:

- Graduation from an accredited school of nursing, with current RN or LPN, or an MSW, or related license, in good standing, as dictated by the client contract

- At least four (4) years of experience working with individuals with a mental health diagnosis and/or intellectual disability, with the primary focus on behavioral health, as dictated by the client contract, plus one (1) year of quality review experience.  In addition, candidates must have a minimum of two (2) years of medical experience with a strong understanding of rehabilitation potential, based on diagnosis, age, disease process and chronicity also as dictated by the client contract

- Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures

- Excellent knowledge of diverse cultures and issues, with the ability to incorporate special needs into utilization review decisions

- Working knowledge and understanding of behavioral health diagnoses, psychotropic medications, medical diagnoses and prescribed medications

- Excellent ability to multitask while effectively performing job duties, which include prioritizing tasks;  ensure all voice mail and email messages are monitored and responded to within 2 hours of receipt

- Ability to work independently, as well as within a team while exhibiting excellent interpersonal skills

- Excellent written and verbal communication skills

- Ability to interact professionally with providers (hospital & nursing home staff, physicians, community service workers, etc.), state contract officers, and coworkers while seeking or providing information

- Ability to collect data, define problems, establish facts, and draw valid conclusions for supporting a superior written rationale for review determination

- Excellent computer skills with experience in word processing, email, and spreadsheets (Microsoft Word, Outlook and Excel preferred)

- Ability to work with dual computer monitors, research information on the internet, utilize company resources/ tools stored on company sites



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Resume, cover letter, or other documents as required per the job description

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