Utilization Management Clinician, Behavioral Health – Precertification

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

📋 Description

• Evaluate behavioral health authorization requests along with clinical documentation to assess medical necessity and suitable levels of care.

• Concentrate on inpatient mental health, detoxification services, and substance use rehabilitation programs.

• Implement evidence-based behavioral health guidelines and clinical practice standards in authorization decisions.

• Apply Medicare coverage criteria and requirements when necessary.

• Accurately and thoroughly document determinations, rationale, and recommendations.

• Collaborate with facilities and providers to gather additional clinical information.

• Assist in discharge planning and transitions of care.

• Relay authorization decisions and subsequent actions to providers and internal stakeholders.

• Identify members who could benefit from further clinical programs, services, or care management assistance.

• Engage in crisis queue coverage, which includes member triage, call handling, escalation, and documentation.

• Spot opportunities to enhance quality, minimize denials, and optimize benefit utilization.

• Work collaboratively with providers, facilities, and interdisciplinary clinical teams.

⛳️ Requirements

• Must possess an active, unrestricted Master's-level Behavioral Health license in the state of residence, such as LMSW, LCSW, LISW, LPC, or an equivalent independent clinical license.

• Alternatively, an active, unrestricted Registered Nurse (RN) license with experience in psychiatric/behavioral health is acceptable.

• At least 1 year of experience in Behavioral Health Utilization Review or Utilization Management.

• A minimum of 3 years of inpatient behavioral health experience within a hospital environment.

• Recent experience in behavioral health or a continuous work history focused on behavioral health.

• Capability to work from 12:00 PM to 8:30 PM EST.

• Strong skills in clinical decision-making and medical necessity review.

• A Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline is required for Behavioral Health Clinicians.

• An Associate Degree in Nursing (ADN) with Behavioral Health experience is necessary for Registered Nurses.

• Experience working with geriatric populations is preferred.

• Familiarity with supporting chronically mentally ill populations.

• Proficient knowledge of Medicare Behavioral Health guidelines.

• Strong typing and keyboarding abilities.

• Ability to operate multiple systems concurrently.

• Excellent documentation and computer skills.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Fully remote opportunity.

• Consistent weekday schedule.