Senior Utilization Review Clinician - Behavioral Health - Remote

Overview

The Senior Utilization Review Clinician plays a crucial role in assessing and ensuring the quality of mental health and substance abuse services for members, collaborating with healthcare providers, and identifying opportunities for process improvements.

In Short

• Perform clinical reviews of mental health and substance abuse services.
• Monitor and assess the appropriateness of care levels.
• Handle complex clinical cases and workflows.
• Conduct prior authorization reviews in accordance with guidelines.
• Collaborate with healthcare providers on treatment plans.
• Identify quality of care issues and potential fraud.
• Engage with medical directors to enhance care quality.
• Train new hires on workflows as a Subject Matter Expert.
• Provide education regarding the behavioral health utilization process.
• Comply with all policies and standards.

Requirements

• Bachelor's degree required.
• 4-6 years of related experience.
• State required licensure (LCSW, LMHC, LPC, or LMHP).
• Ability to assess complex treatment needs.
• Experience with behavioral health services.
• Strong communication skills.
• Team collaboration abilities.
• Knowledge of regulatory guidelines.
• Critical thinking and problem-solving skills.
• Commitment to quality care and member advocacy.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules (remote, hybrid, field, or office).
• Commitment to diversity and equal opportunity.
• Support for candidate journey and accommodations.
• Access to high-quality healthcare programs.
• Innovative health solutions for families and individuals.