Utilization Review Clinician – Behavioral Health

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

📋 Description

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

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

• Assist in utilization management and initiatives for quality enhancement.

• Detect outlier provider performance.

• Execute thorough clinical record assessments.

• Provide tailored coaching to healthcare providers.

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

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

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

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

• Examine behavioral health member data to enhance quality and utilization.

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

• Engage with behavioral health healthcare providers to discuss levels of care and available services.

• 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 regulations.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Graduate from an accredited nursing school or hold a Bachelor's degree.

• 2–4 years of relevant experience.

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

• Master’s degree required for behavioral health clinicians.

• Must possess one of the following: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state/compact state licensure.

• Preferred clinical knowledge to evaluate and/or 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 associated with mental health and substance use disorders is preferred.

• Ability to work Monday through Friday, from 8 AM to 5 PM in an eastern, central, mountain, or pacific time zone.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

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

• Additional incentive options may be included in total compensation.

• Equal opportunity employer dedicated to diversity.