Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and assess the appropriateness of care levels and services from a medical standpoint.

• Review member treatment both prior to, during, and after service delivery.

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

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

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

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

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

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

• Develop and present cases during staffing and integrated rounds.

• Adhere to all organizational policies and standards.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Must possess an active clinician or RN license in North Carolina.

• Experience in behavioral health and utilization review is essential.

• Graduate from an Accredited School of Nursing or hold a Bachelor's degree with 2–4 years of relevant experience.

• Independent practice license and/or state-required licensure is necessary.

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

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

• Preferred clinical knowledge and ability to review and/or evaluate treatment plans related to 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 assess care services related to mental health and substance abuse is preferred.

• Managed care experience is ideal.

• Proficiency in computer skills is required.

• Strong communication and customer service skills are essential.

• Must be available to work Tuesday through Saturday, from 8:00 AM to 5:00 PM.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional forms of incentives may be included in total compensation.

• Benefits may vary based on program eligibility.