Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conduct clinical evaluations and assess care associated with mental health and substance abuse.

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

• Review member treatment prior to, during, and post-services.

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

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

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

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

• Discuss care levels and services with behavioral health healthcare providers.

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

• Develop and present cases during staffing and integrated rounds.

• Adhere to policies and standards while performing other assigned responsibilities.

⛳️ Requirements

• Must be a resident of Oklahoma.

• Graduate from an accredited nursing program or hold a bachelor's degree.

• 2–4 years of relevant experience.

• Valid license to practice independently and/or any state-required licensure.

• Master’s degree is mandatory for behavioral health clinicians.

• Required state/compact licensure includes LCSW, LMHC, LPC, LMFT, LMHP, or RN.

• Preferred clinical knowledge and ability to evaluate mental health and substance abuse treatment plans.

• Preferred understanding of mental health and substance abuse utilization review processes.

• Preferred experience collaborating with providers and healthcare teams to review related care services.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off along with holidays.

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

• Additional incentive options may be part of the total compensation package.