Mental Health/Substance Use Disorder Specialist
Part-time, project-based consulting work
Position is work from home
Risk & Regulatory Consulting, LLC (RRC)
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.
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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.