Utilization Review Clinician – Behavioral Health

This is a fully remote position, open to applicants in Alabama, +12 more states.

📋 Description

• Conduct clinical evaluations and review care pertaining to mental health and substance use disorders.

• Oversee and assess the appropriateness of care levels and services from a medical standpoint.

• Review member treatment before, during, and after the provision of services.

• Execute prior authorization evaluations in line with regulatory standards and criteria.

• Carry out concurrent reviews of inpatient behavioral health care, focusing on treatment requirements and discharge planning.

• Examine behavioral health member data to enhance quality and ensure suitable utilization.

• Educate providers, members, and families regarding the behavioral health utilization process.

• Engage in discussions about care levels and services with behavioral health healthcare providers.

• Collaborate with medical directors and leadership to enhance care quality and operational efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to policies and standards while performing other assigned responsibilities.

⛳️ Requirements

• Graduate from an Accredited Nursing School or hold a Bachelor's degree with 2–4 years of relevant experience.

• Possess a license to practice independently and/or state-required licensure as applicable.

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

• LCSW (Licensed Clinical Social Worker) is compulsory, or LMHC, LPC, LMFT, LMHP, or RN state/compact state licensure is required.

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

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

• Experience collaborating with providers and healthcare teams to review care services for mental health and substance abuse is preferred.

• Candidates with over 5 years of behavioral health experience in hospital-based, acute care, inpatient psychiatric, or behavioral health inpatient environments are highly favored.

• Ideal candidates will have experience managing complex behavioral health populations and working with multidisciplinary teams in a clinical setting.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in total compensation.

• Equal opportunity employer dedicated to promoting diversity.