Clinician, Utilization Management

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

📋 Description

• Assess and finalize initial and ongoing authorization requests.

• Deliver clinical care coordination for behavioral health.

• Manage incoming phone inquiries from the provider network.

• Utilize clinical judgment, medical necessity criteria, and evidence-based practices to make medical necessity determinations.

• Perform thorough behavioral health utilization reviews and assess appropriate levels of care.

• Partner with members, families, providers, and clients to facilitate care coordination.

• Enhance accessibility to behavioral health services.

• Assist in discharge planning and advocate for successful treatment outcomes.

• Ensure accurate documentation and adherence to regulatory and accreditation standards.

• Effectively utilize clinical systems and comply with organizational policies and procedures.

⛳️ Requirements

• A valid, unrestricted license issued by a U.S. state or territory to practice independently as a clinical social worker, marriage and family therapist, professional counselor, clinical psychologist, or registered nurse in the applicable state(s).

• At least two years of direct clinical care experience with patients in facility-based or outpatient psychiatric or substance abuse treatment.

• Exceptional verbal and written communication and interpersonal skills.

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

• Capable of understanding medical policy and criteria and effectively conveying health information.

• Must successfully pass a comprehensive background check upon hiring and throughout employment, including criminal, employment, educational, sanctions, watchlist, sex offender registry, and a 10-panel drug screening.

• High-speed cable or fiber-optic internet connection must be installed prior to starting, with a minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds.

• Must be able to work from a designated workspace at home with minimal background noise.

• Requires a hardwired internet connection and the ability to use company-issued wired headsets and desktop equipment.

• Ability to sit for prolonged periods and engage in repetitive typing and computer tasks.

🏝️ Benefits

• Annual performance-based discretionary incentive.

• Comprehensive medical, dental, and vision coverage.

• 401(k) plan with a competitive employer match.

• 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 expenses.

• Opportunities for professional development and tuition reimbursement.

• Flexibility for remote work (depending on role).

• Opportunities for meaningful personal and professional development.

• Equipment provided by the company.