Utilization Review Clinician – Behavioral Health

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

📋 Description

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

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

• Review members’ treatment throughout the course of services, including before and after interventions.

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

• Carry out concurrent evaluations of inpatient behavioral health care, addressing treatment requirements and discharge strategies.

• Analyze data concerning behavioral health members to enhance service quality and appropriate use.

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

• Collaborate with behavioral health providers to discuss care levels and services offered.

• Work alongside medical directors and leadership to elevate care quality and operational efficiency.

• Prepare and present cases during staffing meetings and integrated rounds.

• Undertake additional responsibilities as needed.

• Adhere to all organizational policies and standards.

⛳️ Requirements

• RN, LCSW, LPC, LMHC, LMFT, or LMHP qualifications are necessary.

• Must hold a valid license in Texas.

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

• 2–4 years of relevant professional experience required.

• Independent practice license and/or state-mandated licensure is essential.

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

• Preferred: Clinical expertise and capability to review or evaluate treatment plans related to mental health and substance use.

• Preferred: Familiarity with the mental health and substance abuse utilization review process.

• Preferred: Experience collaborating with providers and healthcare teams to evaluate care services pertaining to mental health and substance abuse.

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

• Specific to Fidelis Care: LMSW, LCSW, LMHC, LPC, LMFT, LMHP, or RN credentials required.

🏝️ Benefits

• Competitive salary.

• Comprehensive health insurance.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

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

• Potential for additional incentives as part of total compensation.