You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is hiring a Substance Use Disorder (SUD) Clinical Reviewer for a fiscal year 2025-2026 project. The reviewer will be responsible for completing a third-party overread of inpatient and residential SUD denials issued by Managed Care Entities (MCEs) in Colorado.
Key Responsibilities
- Perform retrospective reviews of denial cases by analyzing the same documentation used by the original MCE.
- Make an independent determination on each case (agree or disagree with denial) based on The ASAM Navigator by InterQual (3rd Edition).
- Assess the MCE's application of the ASAM criteria for appropriateness and consistency.
Qualifications
- Has an active behavioral health license in their state (LPC, LCSW, LAC, MAC or equivalent).
- Has experience providing SUD treatment services, preferably in an inpatient/residential setting.
- Has training and experience in utilization of ASAM Criteria (3rd Ed.).
Experience
- Experience with Utilization Review/Utilization management, InterQual experience.
Skills
- Experience with Microsoft software such as Outlook, Teams, and SharePoint.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
- Our client is committed to ensuring equal employment opportunities.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
