Behavioral Health Precertification / Utilization Management Clinician
100% Remote | Monday–Friday | 12:00 PM – 8:30 PM EST
Are you a licensed Behavioral Health professional or Psychiatric RN with Utilization Management experience? Join our team and play a critical role in reviewing behavioral health authorization requests, supporting appropriate levels of care, and ensuring members receive timely, evidence-based treatment.
What You'll Do
As a Behavioral Health Precertification/UM Clinician, you will review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care, with a primary focus on:
- Inpatient Mental Health
- Detoxification Services
- Substance Use Rehabilitation Programs
Key responsibilities include
- Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity
- Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
- Utilize Medicare coverage criteria and requirements when applicable
- Document determinations, rationale, and recommendations accurately and thoroughly
- Coordinate with facilities and providers to obtain additional clinical information when needed
- Support discharge planning and transitions of care
- Communicate authorization decisions and next steps to providers and internal stakeholders
- Identify members who may benefit from additional clinical programs, services, or care management support
- Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation
- Identify opportunities to improve quality, reduce denials, and optimize benefit utilization
WHAT YOU BRING - REQUIRED
- Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as:
- LMSW
- LCSW
- LISW
- LPC
- Equivalent independent clinical license
OR
- Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience
Additionally, candidates must have
- 1+ year of Behavioral Health Utilization Review or Utilization Management experience
- 3+ years of inpatient behavioral health experience in a hospital setting
- Recent behavioral health experience or continuous behavioral health-focused work history
- Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST
- Strong clinical decision-making and medical necessity review skills
Preferred Qualifications
- Experience working with geriatric populations
- Experience supporting chronically mentally ill populations
- Working knowledge of Medicare Behavioral Health guidelines
- Strong typing and keyboarding skills
- Ability to navigate multiple systems simultaneously
- Excellent documentation and computer skills
Education
Behavioral Health Clinicians
- Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline
Registered Nurses
- Associate Degree in Nursing (ADN) with Behavioral Health experience
Preferred
- Bachelor of Science in Nursing (BSN)
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$54,095.00 - $116,760.00