Utilization Review Clinician – Behavioral Health

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Conduct clinical assessments and reviews related to mental health and substance abuse care.

• Oversee and evaluate the appropriateness of care levels and services from a medical perspective.

• Assess member treatment throughout the entire service continuum.

• Execute prior authorization reviews following regulatory standards and criteria.

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

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

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

• Liaise with behavioral health providers regarding care levels and services offered.

• 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 policies and standards while also performing other assigned responsibilities.

⛳️ Requirements

• Graduate from an accredited nursing school or hold a Bachelor's degree with 2–4 years of relevant experience.

• Possess a license to practice independently and/or meet state licensure requirements.

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

• Must hold LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact state licensure.

• Clinical expertise and the ability to review and/or assess treatment plans related to mental health and substance abuse is preferred.

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

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

• Open to applicants located in the eastern, central, or mountain time zones of the United States.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off along with holidays.

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

• Additional incentives may be included in the total compensation package.