Utilization Review Clinician - Behavioral Health

About the role

Reviews will focus on the following settings: residential treatment center, inpatient psychiatric admissions, detox, crisis stabilization unit, PHP, and community based services. Preference will be given to applicants who (1) reside ideally in Mississippi, Louisiana, Arkansas, Texas, or Tennessee, (2) have experience in utilization management/review and (3) in behavioral health settings. (4) Experience with Mississippi market, managed care, Mental Health Residential Services for children, or Juvenile Sex Offender Program is preferred.

Responsibilities

• Performs a clinical review and assesses care related to mental health and substance abuse.
• Makes determinations regarding the appropriateness of level of care and services related to mental health and substance abuse.
• Determines medical appropriateness of prior authorization reviews related to mental health and substance abuse in accordance with regulatory guidelines and criteria.
• Conducts concurrent review of behavioral health (BH) inpatient to evaluate the overall health of the member, treatment needs, and discharge planning.
• Analyzes BH member data to enhance quality and appropriate utilization of services.
• Provides education to providers, members, and their families regarding the BH utilization process.
• Communicates with BH healthcare providers to discuss level of care and/or services.
• Collaborates with medical directors and leadership to improve the quality and efficiency of care.
• Participates in staffing and integrated rounds to formulate and present cases.
• Ensures compliance with all policies and standards.

Requirements

• Graduate of an accredited school of nursing or Bachelor's degree.
• 2-4 years of related experience.
• Independent clinical licensure in the state of practice.
• Master’s degree for behavioral health clinicians required.
• Knowledge of mental health and substance abuse utilization review process preferred.
• Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

Qualifications

• LCSW - License Clinical Social Worker required.
• Licensed Mental Health Counselor (LMHC) - License required.
• Licensed Professional Counselor (LPC) - License required.
• Licensed Marital and Family Therapist (LMFT) - License required.
• Licensed Mental Health Professional (LMHP) - License required.
• RN - Registered Nurse - State licensure and/or compact state licensure required.

Skills

• Strong clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse.
• Understanding 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.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.

Pay

$27.02 - $48.55 per hour.