Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conduct clinical evaluations and assess care concerning mental health and substance use disorders.

• Oversee and ascertain the medical appropriateness of care levels and services.

• Review member treatment prior to, during, and post-services.

• Execute prior authorization reviews in line with regulatory standards and guidelines.

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

• Analyze behavioral health member data to enhance service quality and appropriate utilization.

• Provide education to 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 efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to all policies and standards while fulfilling other assigned responsibilities.

⛳️ Requirements

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

• License to practice independently and/or state-required licensure.

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

• Possession of one of the following licenses/certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN state and/or compact state licensure.

• 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 in reviewing care services related to mental health and substance use disorders is preferred.

• Availability to work the training schedule from Monday to Friday, 8 AM to 5 PM for the initial weeks.

• Capability to work an applicable main schedule, which includes rotating holidays and occasional overtime.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentive forms may be included as part of the total compensation package.