Utilization Review Clinician – Behavioral Health

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

📋 Description

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

• Oversee and ascertain whether the levels of care and services provided are medically appropriate.

• Review member treatment processes before, during, and after services are rendered.

• Carry out prior authorization assessments in line with regulatory requirements and standards.

• Execute concurrent evaluations of inpatient behavioral health care.

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

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

• Engage in discussions regarding levels of care and services with behavioral health healthcare providers.

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

• Develop and present cases during staffing and integrated rounds.

• Adhere to established policies and standards.

• Execute other assigned responsibilities.

⛳️ Requirements

• Graduate from an accredited nursing school or possess a Bachelor's degree.

• 2–4 years of relevant experience.

• An active Washington RN license or an active Compact RN license is mandatory.

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

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

• One of the following credentials is required: LCSW, LMHC, LPC, LMFT, LMHP, or RN State Licensure and/or Compact State Licensure.

• Preferred clinical knowledge and capability to review 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.

• Must be available Monday through Friday from 8:00 AM to 5:00 PM PST.

• Willingness to participate in weekend and holiday rotation schedules.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Commitment to equal opportunity employment.

• Consideration of qualified candidates with arrest or conviction records in accordance with applicable law.