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 use disorders.

• Oversee and assess if the levels of care and services provided are medically suitable.

• Review member treatment at various stages: before, during, and after the provision of services.

• Carry out prior authorization reviews following established regulatory guidelines and criteria.

• Execute concurrent assessments of inpatient behavioral health care, including evaluating treatment requirements and discharge planning.

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

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

• Communicate with behavioral health providers regarding levels of care and available services.

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

• Develop and present cases during staffing and integrated rounds.

• Adhere to all relevant policies and standards.

• Perform additional tasks as assigned.

⛳️ Requirements

• RN, LCSW, LPC, LMHC, LMFT, or LMHP; must be licensed in Texas.

• Experience in outpatient behavioral health.

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

• 2–4 years of relevant experience.

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

• A master’s degree is necessary for behavioral health clinicians.

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

• Preferred clinical knowledge of treatment plans associated with mental health and substance abuse.

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

• Preferred experience collaborating with providers and healthcare teams in reviewing 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 incentives may be included in the overall compensation package.