Summary The Behavioral Health (BH) Utilization Management Reviewer is responsible for clinical review of requested services to determine medical necessity and appropriateness of care in accordance with NCQA, HHSC, TDI, and other regulatory standards. The BH Reviewer evaluates Medicaid and CHIP medical records to determine clinically appropriate and fiscally responsible services by utilizing clinical expertise of appropriate criteria in conjunction with contractual requirements, critical thinking and decision-making skills. The BH Reviewer must maintain set production goals and quality standards when authorizing services requested for the Member. The BH Reviewer must collaborate with appropr
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