Utilization Management Clinician Behavioral Health Remote
Utilization Management Clinician Behavioral Health Remote
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1 Vacancy
Job Description
Job Title: Utilization Management Clinician Behavioral Health (Remote)
Location Requirements:
Candidates must reside in one of the following states: Arizona (AZ) Florida (FL) Georgia (GA) Idaho (ID) Iowa (IA) Kentucky (KY) Michigan (MI) Nebraska (NE) New Mexico (NM) New York (NY outside greater NYC) Ohio (OH) Texas (TX) Utah (UT) Washington (WA) or Wisconsin (WI).
Licensure must be in Washington (WA) regardless of physical location.
Time Zone Requirements:
Pacific Standard Time (PST) hours required.
Work Schedule:
MondayFriday or TuesdaySaturday 9:00 AM 5:00 PM PST
Position Type:
Temporary to Permanent
Compensation:
Up to $45 per hour
Remote Work:
100 Remote
Required Equipment:
In addition to a laptop keyboard mouse and headset candidates will need a monitor and docking station.
Position Summary:
A Managed Care Organization is seeking a Behavioral Health Utilization Management Clinician to support the review of inpatient and outpatient services ensuring appropriate care and resource utilization. This role involves evaluating prior authorization requests and conducting concurrent reviews to determine medical necessity for behavioral health services.
DaytoDay Responsibilities:
Process utilization review cases across various levels of care
Conduct prior authorization and concurrent reviews for behavioral health services
Determine eligibility benefits and expected length of stay
Collaborate with interdisciplinary teams to promote continuity of care
Refer cases to medical directors as appropriate
Maintain productivity and quality performance standards
Participate in team meetings and contribute to onboarding of new clinicians
Adhere to regulatory guidelines organizational policies and HIPAA compliance
MustHave Requirements:
Behavioral Health background
Utilization Management experience
Licensure in the state of Washington as one of the following:
Licensed Independent Clinical Social Worker (LICSW)
Licensed Professional Clinical Counselor (LPCC)
Licensed Mental Health Counselor (LMHC)
Marriage and Family Therapist (LMFT)
Psychiatric Nurse
Registered Nurse (RN)
Preferred Experience:
24 years of clinical experience ideally in hospital settings utilization review or case management
Familiarity with InterQual criteria and NCQA standards
Previous work within a managed care or health plan environment
Knowledge Skills and Abilities:
Excellent communication critical thinking and decisionmaking skills
Ability to manage multiple priorities and work independently
Knowledge of federal/state regulations and behavioral health utilization review protocols
Proficiency with Microsoft Office and electronic medical record systems
Commitment to ethical standards and professional conduct
Employment Type
Hourly
