Consulting - Mental Health Behavioral Specialist - Regulatory Insurance

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Mental Health/Substance Use Disorder Specialist

Part-time, project-based consulting work

Position is work from home

Risk & Regulatory Consulting, LLC (RRC)

 

Position Overview

The Mental Health/Substance Use Disorder Specialist will provide medical/clinical reviews under the guidance of RRC.  

 

Reviews will be based on the level of medical/clinician resource involved in the member’s treatment.  The claim reviews will be medically driven not diagnostic driven, based on the expectation that although the claims under review will involve behavioral health/substance use disorder diagnosis, treatment may not have been provided by a psychologist or a psychiatrist, as counselors or licensed physicians may have provided treatment.  The medical profile of the claim will determine the level of the review required. 

 

A physician/clinician of lesser qualifications than the physician/clinician who provided the treatment will not conduct reviews. 

 

Specific Duties and Responsibilities

Perform and document results of peer-to-peer reviews of claims denials; including but not limited to the following utilization reviews – preauthorization, concurrent and retrospective review denials.  Reviews and documentation will be performed in accordance protocols agreed upon by the Specialist and RRC prior to the beginning of the project.

 

Requirements  

  • Appropriately licensed or certified as one of the following in the state in which professionally practicing:
  • May not currently be working with or have an affiliation with a managed care organization (MCO) which would create a conflict of interest
  • Have a working knowledge of accepted and prevailing professional treatment standards for mental health and/or substance use disorder conditions. 
  • Possess the ability to review and assess patient charts for compliance with professional treatment standards and clinical judgment.
  • Experience in treating individuals with the following conditions is preferable:  
  • Excellent interpersonal communication skills and ability to work collaboratively with other disciplines, is essential
  • Sense of urgency and flexibility in regard to deadlines is necessary
  • Although limited when possible, travel may be required depending on the project

 

 

**When applying please add your resume as an attachment!**

Please do not auto generate resume from LinkedIn

 

 

Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed.  RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients.

 

Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients. 

RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES.

 

 


You want your next step to be the right one. You've worked hard to get where you are today. And now you're ready to use your unique skills, talents and personality to achieve great things. RSM is a place where you are valued as an individual, mentored as a future leader, and recognized for your accomplishments and potential. Working directly with clients, key decision makers and business owners across various industries and geographies, you'll move quickly along the learning curve and our clients will benefit from your fresh perspective.

Experience RSM US. Experience the power of being understood.

RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.
Job ID req4377
Line of Business: Risk & Regulatory Consulting
SubFunction: RAS AML & Reg Compliance
Job Type: Full Time
Req #: req4377
Location: 1185 Ave of the Americas, , New York, NY US
Region: National
Job Category: Business Consulting/Technology
Employment Type: Experienced
Degree Required: Bachelor
Travel: No
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