Utilization Review Clinician – Behavioral Health

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

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

• Oversee and ascertain whether the levels of care and services are medically suitable.

• Review members’ treatment prior to, during, and following the provision of services.

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

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

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

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

• Engage in discussions regarding levels of care 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.

• Perform additional duties as assigned.

⛳️ Requirements

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

• Possess a license for independent practice and/or state-mandated licensure.

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

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

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

• Knowledge of the utilization review process for mental health and substance abuse is preferred.

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

• Over 5 years of behavioral health experience in a hospital-based, acute care, inpatient psychiatric, or behavioral health inpatient environment is highly preferred.

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

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus 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 diversity.