Utilization Review Clinician - Behavioral Health - Remote

Overview

This position offers the opportunity to make a significant impact on the lives of 28 million members by performing clinical reviews and assessments related to mental health and substance abuse.

In Short

• Remote position with weekend and holiday rotation potential.
• Work schedule is 8 AM - 5 PM PST.
• Requires RN with compact license and behavioral health experience.
• Conduct clinical reviews for mental health and substance abuse services.
• Perform prior authorization reviews for medical appropriateness.
• Analyze behavioral health member data for quality improvement.
• Educate providers, members, and families about the utilization process.
• Collaborate with healthcare providers and medical directors.
• Present cases in staffing and integrated rounds.
• Comply with all policies and standards.

Requirements

• Graduate of an Accredited School of Nursing or Bachelor's degree.
• 2-4 years of related experience required.
• Master’s degree for behavioral health clinicians preferred.
• Clinical knowledge of treatment plans related to mental health.
• Experience with utilization review process preferred.
• Working experience with healthcare teams is preferred.
• Required licensure: LCSW, LMHC, LPC, LMFT, or RN.
• State licensure as applicable.

Benefits

• Competitive pay and comprehensive benefits package.
• Health insurance and 401K options available.
• Tuition reimbursement and paid time off.
• Flexible work approach including remote, hybrid, and field options.
• Equal opportunity employer committed to diversity.