Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and evaluate the appropriateness of care levels and services provided.

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

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

• Carry out concurrent reviews for behavioral health inpatient care, including evaluating treatment requirements and discharge planning.

• Analyze data related to behavioral health members to enhance service quality and ensure suitable 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 the quality and efficiency of care.

• Develop and present cases during staffing and integrated rounds.

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

⛳️ Requirements

• Graduate from an accredited nursing program or possess a Bachelor’s degree.

• 2–4 years of relevant experience.

• License to practice independently and/or required state licensure.

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

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

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

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

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

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

• Equal opportunity employer dedicated to promoting diversity.