Utilization Review Clinician_Behavioral Health

Position Purpose

Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.

Schedule & Location

Applicants must reside in Central or Eastern Time zones. The schedule is non-traditional requiring a set schedule including both weekend days; either Thursday thru Sunday or Saturday thru Tuesday, 4-10 hour shifts beginning no earlier than 9am Eastern.

Responsibilities

• Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
• Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
• Analyzes BH member data to improve quality and appropriate utilization of services
• Provides education to providers members and their families regrading BH utilization process
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
• Engages with medical directors and leadership to improve the quality and efficiency of care
• Formulates and presents cases in staffing and integrated rounds
• Performs other duties as assigned
• Complies with all policies and standards

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience
• License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required
• Master's degree for behavioral health clinicians required

Preferred Skills

• Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse
• Knowledge of 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

Required Licenses/Certifications

• LCSW – Licensed Clinical Social Worker required or
• LMHC – Licensed Mental Health Counselor required or
• LPC – Licensed Professional Counselor required or
• Licensed Marital and Family Therapist (LMFT) required or
• Licensed Mental Health Professional (LMHP) required or
• RN – Registered Nurse – State Licensure and/or Compact State Licensure required

Pay

$27.02 - $48.55 per hour