Utilization Review Clinician – Behavioral Health

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

📋 Description

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

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

• Review member treatment processes before, during, and after service delivery.

• Execute prior authorization assessments in line with regulatory guidelines 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 the quality and usage of services.

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

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

• Engage with medical directors and leadership to elevate care quality and operational efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to all policies and standards.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Graduate from an accredited nursing school or possess a bachelor's degree.

• 2 to 4 years of relevant experience.

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

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

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

• Preferred clinical knowledge and capability 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 concerning mental health and substance abuse is preferred.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements with options for remote, hybrid, field, or office schedules.

• Competitive compensation.

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