Utilization Review Clinician - Behavioral Health - Remote | WFH

Join our dynamic Medical Management/Health Services team and make a meaningful impact on the lives of over 28 million members! We're a nationally recognized organization committed to providing top-tier benefits and fostering a supportive work environment where flexibility is valued.

As a Clinical Professional, you'll play a pivotal role in ensuring the well-being of our members. Key responsibilities include evaluating and monitoring mental health and substance abuse treatments, conducting prior authorization reviews, and performing concurrent reviews for inpatient behavioral health services. Your expertise will guide decision-making processes to ensure the delivery of medically appropriate care.

Additionally, you'll leverage your clinical knowledge to analyze member data, identify opportunities for quality improvement, and provide education to both providers and members regarding behavioral health utilization processes. Collaboration is at the heart of what we do, and you'll engage with healthcare providers, medical directors, and leadership to enhance the quality and efficiency of care delivery.

This role requires a strong educational background, including a graduate degree from an accredited nursing school or a bachelor's degree with relevant experience. You must hold current licensure in either the Compact or Georgia state, with specific licensure as outlined by state regulations. A master's degree is required for behavioral health clinicians, and preference is given to candidates with prior experience in mental health and substance abuse utilization review processes.

We're seeking candidates with a passion for improving healthcare outcomes and a commitment to upholding the highest standards of care. If you're ready to make a difference and join a team dedicated to transforming healthcare, we invite you to apply. Compensation ranges from $25.00 to $44.85 per hour, commensurate with experience and qualifications.

Employment Type: Full-Time