Clinician, Utilization Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Review and finalize initial and concurrent authorization requests

• Deliver exceptional customer service and member support

• Perform thorough behavioral health utilization assessments

• Utilize medical necessity criteria, clinical judgment, and evidence-based practices for determining levels of care

• Collaborate with members, families, providers, and clients to ensure coordinated care

• Facilitate access to behavioral health services

• Assist in discharge planning and support positive treatment outcomes

• Maintain precise documentation and effectively utilize clinical systems

• Ensure compliance with regulatory and accreditation standards

• Manage incoming phone communications from the provider network

• Work independently to achieve caseload targets and team goals

⛳️ Requirements

• Current, unrestricted license from a state or territory in the United States to practice independently as a clinical social worker, marriage and family therapist, professional counselor, clinical psychologist, or registered nurse

• At least two years of direct clinical care experience with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment

• Outstanding verbal and written communication and interpersonal skills

• Proficient computer and typing skills, including the ability to document while receiving information over the phone

• Capability to understand medical policy and criteria, and to clearly communicate health information

• Must pass background checks upon hiring and throughout employment, including criminal, identity, education, employment, sanctions, watchlist, sex offender registry, and 10-Panel Drug Screen checks

• High-speed internet connection with a minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds

• Wired internet connection required

• Ability to work from a fixed, designated workspace in the home

• Capacity to sit for extended durations and utilize wired headsets and desktop equipment

🏝️ Benefits

• Annual performance-based discretionary incentive

• Medical, dental, and vision insurance coverage

• 401(k) plan with competitive employer matching

• Company-sponsored life and disability insurance

• Paid parental leave and wellness incentives

• Generous paid time off, including time for volunteering

• Flexible spending accounts for healthcare and dependent care

• Opportunities for professional development and tuition reimbursement

• Flexibility for remote work (dependent on role)

• Potential for meaningful personal and professional growth

• Equipment provided by the company