Behavioral Health Specialist -- Remote

Date Posted: 06/10/2021

Equity Staffing is searching for an experienced Behavioral Health Specialist for a Telecommute Position . This position is with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!


This position requires behavioral health experience and utilization management experience.
Can be a RN, a Licensed Clinical Social Worker or Master of Social Work or any behavioral health license.


Position Description:
Collect case specific member information, review and certify the medical necessity of prospective, concurrent, and retrospective units of inpatient and outpatient services. Review each case and determine the most appropriate services, the most appropriate setting in which the services should be delivered, the most cost efficient methods for care of delivery, and the need for planning subsequent care for contracted members and their eligible dependents as assigned.
Providing clinical and managed care expertise, as well as Medical Director/physician consultation.
Provide first level clinical review for all inpatient and outpatient services requiring authorization for assigned client group regarding: Prospective Review Urgent/ Non-urgent, Concurrent Review, Retrospective Review, Early initiation of discharge coordination, Analyze case-specific patient information.
Verify eligibility, as applicable, and past utilization history. Client-specific protocol and procedures Identifying and reporting quality of care issues.
Answer telephone calls promptly as scheduled and as needed.
Maintain working knowledge of all client groups
Demonstrate adequate competence in computer software use in daily activities.
Review case-specific patient information concurrently for the medical necessity of hospital admissions using commercial review criteria and/or scripted guidelines.
Based on severity or complexity of the client's condition, ability to meet commercial review criteria and or scripted guidelines, the necessary treatment, and the discharge planning activity (not routinely conducted on a daily basis), the nurse reviewer will assign the appropriate LOS days / visits / services in review of the clinical information obtained.
Ensure timely notification of all parties (telephonic and/or written), as necessary, regarding certification recommendations. Prepare case files for physician review via Physician Consultant Services or Medical director.
This includes preparation of clinical information; correspondence.
Function as a member of a self-directed team to meet specific individual and team performance metrics.
Telephonic discussions with health care providers and members to explain medical necessity determinations and to obtain additional clinical information.
Ensure consistent application of the utilization review process for all functional components.
Document case review findings, actions, and outcomes in accordance with policy. Participate in special projects, as needed
Participate in team meetings.
Review clinical coverage reviews and assure client recommendations, as designated.
Manage workload to ensure timely processing per state and federal mandates

Qualifications include:
Active RN licensure OR Behavioral Health licensure; minimum of 2 year clinical experience.
Previous Utilization Management experience required. Sound clinical judgment
Demonstrated understanding of managed care concepts, Strong problem solving and decision making skills
Strong departmental team player, Good written and verbal communication skills
Personal computer skills, Strong time management and prioritization skills
Excellent customer service skills including a sense of urgency and ownership for resolving issues
Strong interpersonal skills at an individual and team level
Ability to be flexible, adjust quickly and react positively to change
Knowledge of ICD-10 and CP coding helpful
Considerable knowledge of principles, practices and current trends in nursing
Positive attitude and good work ethics
Microsoft programs

Monday-Friday 8am-5pm
Phone interview
Worksite = remote 100%



Equity Staffing Group is one of the fastest growing Native American owned staffing companies in the United States. We are a certified Minority Business Enterprise (MBE) by the National Minority Supplier Development Council (NMSDC) and the Rocky Mountain Minority Supplier Development Council (RMMSDC).

Equity Staffing Group is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Equity Staffing Group will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.
We welcome you to learn more about our company by visiting www.equitystaffing.com.
Equity Staffing Native American owned staffing companies in the United States. We are a certified Minority Business Enterprise (MBE) by the National Minority Supplier Development Council (NMSDC) and the Rocky Mountain Minority Supplier Development Council (RMMSDC).

Equity Staffing Group is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Equity Staffing Group will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

We welcome you to learn more about our company by visiting www.equitystaffing.com


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Testimonials

"I was so impressed with the outstanding service that Equity Staffing provided in placing me in my current position.  I wasn’t sure I would be a good candidate for this position, but my recruiter and Equity’s Account Manager took the time to go over the job description and how my experience and skill set would fit in perfectly with this job assignment.  I am glad I took their advice, because I am now on contract with a great company working with a professional staff and learning how to support a management team in an industry I have never worked in before.” 

Lisa M.

Denver, CO

“I’ve been an IT contractor for 9 years, and in that time I’ve been exposed to numerous IT staffing firms and consulting agencies, big and small.  Equity impressed me immediately.  My recruiters quickly and efficiently connected me with a great tech company whose needs in both personality and tech proficiency matched my wheelhouse in addition to a healthy dose of career progressing tech challenges.  And a 12 minute drive from my house no less.  That’s huge for me.  They were willing to meet face to face before the client company interview which, in my experience, is critical to the staffing firm / contractor relationship.  Equity is organized, modern, and professional, and my recruiters were very pleasant to work with, responsive, and generous with their time.  I’m grateful for all they’ve done for me.”

Christopher S.

Minneapolis, MN

“Working as a consultant for Equity Staffing Group has been a wonderful experience.  My recruiter was a true professional throughout the entire process.  Equity separates itself from other staffing companies I have worked with in past because they provided wonderful customer service, they had benefits offerings,  the onboarding was easy and efficient but best of all they followed up with me prior to my assignment ending and found my next assignment shortly afterward.  I highly recommend the professionals at Equity Staffing Group!”

Tamika B.

Atlanta, GA

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