Utilization Review Clinician – Behavioral Health

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

📋 Description

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

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

• Review member treatment processes before, during, and after service delivery

• Execute prior authorization assessments in accordance with regulatory standards 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 service quality and appropriate utilization

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

• Collaborate with behavioral health healthcare providers on levels of care and services

• Work with medical directors and leadership to enhance quality and efficiency of care

• Develop and present cases during staffing and integrated rounds

• Adhere to all policies and standards while performing additional assigned responsibilities

⛳️ Requirements

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

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

• Must hold the necessary license for independent practice and/or state-required licensure

• One of the following credentials 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 related to mental health and substance use

• 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

• Candidates with experience in hospital-based behavioral health or inpatient psychiatric settings are strongly preferred

• Participation in a holiday rotation is mandatory

🏝️ Benefits

• Health insurance

• 401K

• Stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

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

• Additional incentives may be included in the overall compensation package

• Equal opportunity employer