Utilization Review Clinician – Behavioral Health

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

📋 Description

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

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

• Execute behavioral health clinical assessments for both inpatient and outpatient care supporting Oregon Medicaid.

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

• Carry out prior authorization evaluations in line with regulatory standards and criteria.

• Conduct concurrent reviews of inpatient behavioral health care, focusing on treatment necessities and discharge planning.

• Analyze data pertaining to behavioral health members to enhance quality and 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.

• Work closely with medical directors and leadership to enhance care quality and operational efficiency.

• Develop and present cases during staffing and integrated rounds.

• Adhere to all policies and standards.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Graduate from an Accredited Nursing School or possess a Bachelor's degree.

• 2–4 years of relevant experience.

• Independent clinical licensure and/or state-mandated licensure.

• 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 state/compact state licensure.

• Preferred clinical knowledge and capability to review and/or evaluate treatment plans concerning 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 in reviewing care services related to mental health and substance abuse is preferred.

• Applicants can be located in any time zone within the United States.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in the overall compensation package.