Behavioral Health-Lead Clinical Reviewer (100% remote home-based)

Alexandria, VA 22301

Posted: 10/03/2021 Industry: Behavioral Health Job Number: CH Lead DC CR-Alex

Job Description

Fully 100% Remote, home-based

Will serve as the Lead Clinical Reviewer to assess the medical necessity and quality of healthcare services by conducting prospective, concurrent, and retrospective utilization management reviews. This position serves as a substance use disorder subject matter expert and leads a clinical team reviewing appropriate level of care placement and service needs for individuals receiving residential treatment for substance use disorders, based on the nationally recognized ASAM criteria. This position is also responsible for training community clinicians on the ASAM Continuum, appropriate documentation, and other SUDs related issues. This work focuses on improving treatment outcomes at the individual and community level.

Job Requirements


  • Apply clinical review criteria, guidelines, and screens to determine the medical necessity of health care services.
  • Lead Supervisor of Clinical Review Team
  • Provides training on ASAM criteria and use of the Continuum and CoTriage tools, documentation, and other SUDs related issues.
  • Consults with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens.
  • Acts as a resource for peers and or others (care management staff) regarding the matter of utilization review related questions and or review processes.
  • Assists with the appeal case preparation for medical affairs and in accordance or departmental or organizational policies
  • Provides daily oversight and monitoring of non-clinical staff during their performance of non-clinical support activities; also provide the supervisor with input regarding employees’ performance of these activities.
  • Provides clinical and/or review process subject matter expertise


  • Demonstrated competence in the assessment and treatment of mental health disorders
  • MA / MS or above in psychology, counseling, or social work from an accredited institution

  • Current credential or license as a Substance Use Disorders/Addiction counselor

  • Current, active, unrestricted clinical licensure to provide behavioral health independently in any state

  • Must be willing to obtain unrestricted clinical licensure to provide behavioral health independently in Washington DC within 30 day of employment

  • Certified/eligible to be certified as Master Addiction Counselor

  • 5 + years of direct patient care in behavioral health that includes at least 3 years of primarily treating substance use disorders.

  • 2+ years of utilization review (or other medical management experience) preferred

Additional Information

Our client is a national, privately held, non-profit, financially stable company providing healthcare quality, process improvement and safety project services with federal and state organizations such as Medicare, Medicaid and Indian Health Services. They are viewed as a major player in this industry.

The is a permanent, full-time position with a market-based salary, excellent corporate benefits including full health, dental, vision (my client pays 75% of premiums for both the employer and their dependents!), 3% matching retirement, PTO and much more. In addition, they offer the PSLF-Public Student Loan Forgiveness.

Let's schedule a call to specifically discuss your career direction, our client and the position in depth. I look forward to speaking with you.



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