Utilization Review Clinician – Behavioral Health

This is a fully remote position, open to applicants in Kansas, +3 more states.

📋 Description

• Conduct clinical evaluations and review care pertaining to mental health and substance abuse.

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

• Assist with utilization management and initiatives for quality enhancement.

• Identify providers whose performance deviates from expected standards.

• Execute thorough reviews of clinical records.

• Provide tailored coaching to healthcare providers.

• Compile findings into actionable presentations for both providers and health plan executives.

• Assess member treatment at various stages: before, during, and after services.

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

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

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

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

• Engage in discussions regarding care levels and services with behavioral health practitioners.

• Collaborate with medical directors and leadership to enhance the quality and efficiency of care.

• 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 School of Nursing or possess a Bachelor's degree with 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.

• Licensure as LCSW, LMHC, LPC, LMFT, or LMHP is mandatory, or RN state licensure and/or compact state licensure is required.

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

• 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 abuse is preferred.

• Preference for experience in diverse mental health environments, particularly outpatient and residential treatment services.

• Preference for experience in utilization management/review.

• Preference for experience in presenting to leadership/providers and advising on provider performance.

• Availability to work Monday through Friday, 8–5 PM in Eastern, Central, Mountain, or Pacific time zones.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

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

• Additional incentive options may be included in the overall compensation package.