Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and determine the medical appropriateness of care levels and services.

• Review members’ treatment both prior to, during, and following services.

• Execute prior authorization assessments in accordance with regulatory standards and criteria.

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

• Examine behavioral health member data to enhance quality and 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 care quality and efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to policies and standards.

• Perform additional duties as assigned.

⛳️ Requirements

• Fully remote role requiring availability Monday through Friday from 8:30 a.m. to 5:00 p.m. Eastern Time.

• A valid, applicable clinical license is required; New York State licensure is strongly preferred.

• Graduation from an accredited nursing program or possession of a bachelor’s degree.

• 2–4 years of relevant experience.

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

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

• For Fidelis Care applicants only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP, or RN credentials are required.

• Preferred clinical knowledge and capability to review and/or assess treatment plans related to mental health and substance use disorders.

• Knowledge of the mental health and substance abuse utilization review process is preferred.

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

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off, in addition to holidays.

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

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