Utilization Review Clinician - Behavioral Health
About The Position
The Utilization Review Clinician performs clinical reviews and assesses care related to mental health and substance abuse. The role monitors care and determines whether levels of care and services are medically appropriate. This is a remote position requiring an active Georgia Licensed Clinician or Compact Nursing License and behavioral health experience. The schedule is Sunday through Thursday, 8:00 AM to 5:00 PM, with rotating holidays and weekends. The position requires a graduate of an accredited nursing school or a bachelor's degree and 2–4 years of related experience. A master's degree is required for behavioral health clinicians. Candidates must hold a qualifying independent clinical license or nursing license, as applicable.
Requirements
- Graduate of an accredited nursing school or bachelor's degree.
- 2–4 years of related experience.
- Behavioral health experience.
- Active Georgia Licensed Clinician or Compact Nursing License.
- Independent practice license and/or state-required licensure, as applicable.
- For behavioral health clinicians, a master's degree is required.
- One of the following is required: LCSW, LMHC, LPC, LMFT, LMHP, or RN state licensure and/or Compact State Licensure.
Nice To Haves
- Computer savvy.
- Provider-facing experience.
- Excellent communication and customer service skills.
- Highly organized and able to adapt quickly to change.
- Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse.
- Knowledge of the mental health and substance abuse utilization review process.
- Experience working with providers and healthcare teams to review care services related to mental health and substance abuse.
Responsibilities
- Evaluate members’ mental health and substance abuse treatment before, during, and after services to ensure levels of care and services are medically appropriate.
- Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria.
- Perform concurrent reviews of behavioral health inpatient care to assess members’ overall health, treatment needs, and discharge planning.
- Analyze behavioral health member data to improve quality and appropriate utilization of services.
- Educate providers, members, and families about the behavioral health utilization process.
- Interact with behavioral health healthcare providers as appropriate to discuss levels of care and/or services.
- Engage with medical directors and leadership to improve the quality and efficiency of care.
- Formulate and present cases in staffing and integrated rounds.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible approach to work, with remote, hybrid, field, or office schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
