Inpatient Utilization Review Clinician, Behavioral Health

Role Overview

• 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
• 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 regarding 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.

Requirements

• 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
• Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred
• 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
• LCSW
• License 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

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules