Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and assess the appropriateness of care levels and services provided.

• Review behavioral health authorizations for inpatient, residential treatment, and partial hospitalization environments.

• Assess member treatment prior to, during, and following service delivery.

• Execute prior authorization evaluations in accordance with regulatory guidelines and criteria.

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

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

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

• Engage in discussions about levels of care and services with behavioral health 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 while performing additional assigned tasks.

⛳️ 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-required licensure.

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

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

• Clinical knowledge and the ability to evaluate and/or assess treatment plans related to mental health and substance abuse are preferred.

• Familiarity with the mental health and substance abuse utilization review process is preferred.

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

• Preference will be given to applicants residing in the Central or Eastern United States time zones.

• Availability from Monday to Friday, 8:00 a.m. to 5:00 p.m. Eastern or Central time is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase programs.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in overall compensation.