Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and determine if levels of care and services are medically suitable.

• Assess member treatment prior to, during, and following services.

• Execute prior authorization reviews in compliance with regulatory standards and criteria.

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

• Analyze behavioral health member data to enhance quality and service utilization.

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

• Collaborate with behavioral health providers concerning levels of care and services.

• Engage with medical directors and leadership to elevate care quality and efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to all policies and standards.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Candidates must be residents of Louisiana.

• An active, unrestricted Louisiana license is mandatory.

• Must be available to work consistently from either Sunday to Thursday or Tuesday to Saturday, 8:00 AM to 5:00 PM CST.

• A graduate of an accredited nursing school or possess a bachelor's degree.

• 2–4 years of relevant experience is required.

• A license to practice independently and/or state-mandated licensure is necessary.

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

• One of the following licenses/certifications is required: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state and/or compact state licensure.

• Preferred: Clinical knowledge and the ability to review and/or assess treatment plans related to mental health and substance abuse.

• Preferred: Understanding of the mental health and substance abuse utilization review process.

• Preferred: Experience collaborating with providers and healthcare teams to evaluate care services related to mental health and substance use disorders.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentive forms may be incorporated into total compensation.