Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conduct clinical assessments and reviews related to mental health and substance use disorders.

• Monitor and evaluate the appropriateness of care levels and services provided.

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

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

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

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

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

• Engage in discussions about care levels and services with behavioral health healthcare providers.

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

• Develop and present cases during staffing meetings and integrated rounds.

• Carry out additional assigned responsibilities and adhere to established policies and standards.

⛳️ Requirements

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

• 2–4 years of relevant experience in the field.

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

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

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

• Preferred clinical knowledge and ability to review and assess treatment plans for 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 relevant care services is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Options for stock purchase plans.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in total compensation packages.

• An equal opportunity employer dedicated to promoting diversity.