Inpatient Utilization Review Clinician, Behavioral Health

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

📋 Description

• Conducts clinical evaluations and assesses care related to mental health and substance use disorders.

• Monitors and evaluates the appropriateness of care levels and services linked to mental health and substance use.

• Reviews members’ treatments for mental health and substance use before, during, and after services to confirm that care levels and services are medically appropriate.

• Executes prior authorization reviews pertaining to mental health and substance use to ascertain medical appropriateness according to regulatory standards and criteria.

• Conducts concurrent reviews of behavioral health (BH) inpatient cases to assess members' overall health, treatment needs, and discharge planning.

• Analyzes BH member data to enhance service quality and appropriate utilization.

• Offers education to providers, members, and their families on the BH utilization process.

• Collaborates with BH healthcare providers as necessary to discuss care levels and/or services.

• Engages with medical directors and leadership to enhance the quality and efficiency of care.

• Formulates and presents cases during staffing and integrated rounds.

• Performs additional duties as assigned.

• Adheres to all policies and standards.

⛳️ Requirements

• Graduate of an accredited nursing school or possess a bachelor's degree with 2 – 4 years of relevant experience.

• Hold a license to practice independently, and/or have obtained the required state licensure as specified by applicable state regulations.

• A master’s degree is required for behavioral health clinicians.

• Preferred clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance use.

• Familiarity with the mental health and substance use utilization review process is preferred.

• Prior experience collaborating with providers and healthcare teams to review care services related to mental health and substance use is preferred.

• LCSW - Licensed Clinical Social Worker, or LMHC - Licensed Mental Health Counselor, or LPC - Licensed Professional Counselor, or Licensed Marriage and Family Therapist (LMFT), or Licensed Mental Health Professional (LMHP), or RN - Registered Nurse with state licensure and/or compact state licensure is required.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work options including remote, hybrid, field, or office schedules.