Utilization Review Clinician – Behavioral Health

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

📋 Description

• Conducts clinical evaluations and assesses care pertaining to mental health and substance use disorders.

• Monitors and evaluates the appropriateness of the level of care and services related to mental health and substance use disorders.

• Reviews member treatment for mental health and substance use disorders before, during, and after services to ensure medical appropriateness of care and services.

• Executes prior authorization reviews associated with mental health and substance use disorders to ascertain medical appropriateness in line with regulatory guidelines and criteria.

• Performs concurrent reviews of behavioral health (BH) inpatient cases to assess the overall health of members, their treatment needs, and discharge planning.

• Analyzes BH member data to enhance quality and appropriate utilization of services.

• Provides educational resources to providers, members, and their families regarding the BH utilization process.

• Collaborates with medical directors and leadership to enhance the quality and efficiency of care.

• Develops and presents cases during staffing and integrated rounds.

⛳️ Requirements

• Graduate of an Accredited School of Nursing or holds a Bachelor's degree.

• 2 to 4 years of relevant experience.

• Must possess a license in the state of Washington.

• Clinical knowledge and capability to review and/or assess treatment plans related to mental health and substance use disorders are preferred.

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

• Experience in collaborating with providers and healthcare teams to review care services related to mental health and substance use disorders is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans available.

• Tuition reimbursement options.

• Paid time off plus holidays.

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