Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conduct clinical assessments and reviews pertaining to mental health and substance abuse care.

• Oversee and evaluate the appropriateness of care levels and services from a medical perspective.

• Review member treatment prior to, during, and following service delivery.

• 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 appropriate utilization.

• Provide education to providers, members, and families about the behavioral health utilization process.

• Collaborate with behavioral health healthcare providers concerning levels of care and services.

• Work alongside medical directors and leadership to enhance care quality and operational efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to all organizational policies and standards.

• Undertake additional duties as required.

⛳️ Requirements

• Graduate from an Accredited School of Nursing or possess a Bachelor's degree.

• 2–4 years of relevant experience.

• Valid license to practice independently and/or state-mandated licensure.

• Master's degree is required for behavioral health clinicians.

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

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

• Preferably familiar with the mental health and substance abuse utilization review process.

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

• Availability to work Monday through Friday, from 9–6 pm or 9:30 am–6 pm Pacific time, with rotating holidays and potential overtime.

• Open to candidates in other states, provided they can adhere to the specified Pacific Time schedule.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the total compensation package.

• Equal opportunity employer dedicated to promoting diversity.