Behavioral Health Utilization Reviewer (Lpcc, Lmft, Lcsw, Or Rn)

Adolescent Growth Inc. is a network of mental health care programs founded in 2005. Our mission is to positively impact the lives of our clients, community, and employees. We provide a range of mental health services to adolescents with serious mental illness, partnering mainly with insurance companies to ensure quality care for their members. Our company is constantly expanding, and by joining our team at Adolescent Growth, Inc., you will play a crucial role in empowering individuals on their path to recovery.

We are seeking a marriage and family therapist or clinical social worker to perform utilization reviews at our corporate office in Pasadena, California. We believe that offering an attractive benefits package is crucial for attracting top candidates, which is why we provide a comprehensive benefits package that includes healthcare plans (such as vision, dental, and medical), holiday pay, sick time, and paid time off for eligible employees.

In order to qualify for the position, a valid CA state licensure is required. The role involves working closely with other members of the clinical team to authorize and review the utilization of mental health and substance abuse services that are provided in residential treatment programs and/or outpatient care settings. The responsibilities include ensuring that the utilization of these services is appropriate and necessary for the patients and that they are receiving the best possible care. Collects and analyzes utilization data.

Monitors residential treatment services and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.

The ideal candidate performs concurrent reviews for residential inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.

In conjunction with providers and facilities, develop discharge plans and oversee their implementation.

Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the client in treatment.

Provides information to clients and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures and criteria.

Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.

Participates in quality improvement activities, including data collection, tracking, and analysis.

Advocates for the client to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.

Skill Proficiency Requirements:
Dual diagnosis experience with mental health and substance abuse

Excellent communication skills

Experience in a managed care environment, hospital, or residential treatment program

Inpatient setting experience

Ability to learn and navigate multiple proprietary software applications

Ability to thrive in a fast-paced environment

Rate proficiency with Microsoft Office Suite programs (Word, Outlook, Internet)

Certification Requirements:
Master's degree in Psychology, Social Work, Counseling