Social Worker (LCSW) or Counselor (LPC) - Health Review

Norfolk, VA
Mar 02, 2018
Mar 27, 2018
Full Time
Job Description:
Optima Health Community Care is seeking a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) to service and provide community mental health documentation review for the continuation of services. This is an office-based position located at our office in Norfolk, VA. Hours are 8am-5pm Mondays-Fridays.

Responsible for review of clinical information received from Community Mental Health and Rehab Service Providers and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to DMAS clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, CMHRS services, DMAS protocols for such services, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self-funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.

Education Level
Master's Level Degree - COUNSELING OR
Master's Level Degree - SOCIAL WORK

Required: Clinical - 2 years

Preferred: None, unless noted in the “Other” section below

Required: License Clinical Social Worker, License Professional Counselor

Preferred: None, unless noted in the “Other” section below


Preferred: None, unless noted in the “Other” section below

2 years of Clinical experience working with mental health and substance use disorders acute or assessment is required. CMHRS experience preferred. 3 years of experience working with vulnerable populations is required. BLS certification preferred.

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