Utilization Review Clinician – Behavioral Health

This is a fully remote position, open to applicants in Florida, +6 more states.

📋 Description

• Conduct clinical assessments and reviews pertaining to mental health and substance use disorders.

• Oversee and evaluate the appropriateness of care levels and services offered.

• Assess members’ treatment phases before, during, and following services.

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

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

• Analyze data related to behavioral health members to enhance service quality and proper utilization.

• Inform providers, members, and families about the behavioral health utilization process.

• Collaborate with behavioral health care providers regarding services and care levels.

• Partner with medical directors and leadership to elevate the quality and efficiency of care.

• Develop and present cases during staffing meetings and integrated rounds.

• Adhere to all policies and standards.

• Perform additional responsibilities as assigned.

⛳️ Requirements

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

• 2–4 years of relevant experience.

• License to practice independently and/or necessary state 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 with state and/or compact state licensure.

• Preferred clinical knowledge and capability to review and assess 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 related to mental health and substance use disorders is preferred.

• Must be available to work Monday through Friday, from 9:00 AM to 6:00 PM Eastern Time.

• Willingness to participate in a rotating weekend schedule, approximately every seventh weekend.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• 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 programs may be included in the overall compensation package.

• Equal opportunity employer dedicated to diversity.