Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conduct clinical evaluations and assess care associated with mental health and substance use disorders.

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

• Review member treatment prior to, during, and following service delivery.

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

• Carry out concurrent reviews of inpatient behavioral health care, focusing on treatment requirements and discharge strategies.

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

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

• Collaborate with behavioral health providers about care levels and services.

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

• Develop and present cases during staffing and integrated rounds.

• Adhere to policies and standards.

• Carry out additional tasks as assigned.

⛳️ Requirements

• Possess an active Georgia Licensed Clinician or Compact Nursing License.

• Experience in the behavioral health field is required.

• Proficient in computer use.

• Experience interacting with providers.

• Exceptional communication and customer service abilities.

• Highly organized and capable of swiftly adapting to changes.

• Availability Monday through Friday, 8:00 AM to 5:00 PM, including rotating holidays and weekends.

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

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

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

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

• Preferred clinical knowledge with the ability to review and/or evaluate mental health and substance abuse treatment plans.

• Familiarity with the mental health and substance abuse utilization review process is preferred.

• Experience collaborating with providers and healthcare teams on related care services is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentives may be included in overall compensation.

• Equal opportunity employer dedicated to diversity.