Utilization Review Clinician - Behavioral Health

Perform clinical reviews and assess care related to mental health and substance abuse for a national managed care organization. Operate within a 24/7 behavioral health UR call center environment on a Sunday–Thursday schedule (7am-4pm, 8am-5pm, or 9am-6pm CST), with occasional holiday coverage.

Evaluate member treatment for mental health and substance abuse before, during, and after services to ensure level of care is medically appropriate. Perform prior authorization reviews and concurrent review of BH inpatient stays to determine treatment needs and discharge planning. Apply ASAM criteria to assess SPMI needs. Analyze BH member data to improve quality and appropriate utilization. Educate providers, members, and families on the BH utilization process. Interact with BH providers to discuss level of care, and engage with medical directors and leadership in staffing and integrated rounds.

Requirements: RN (Texas state license or compact valid in TX), or LCSW/LPC/LMFT licensed in Texas. Applicants may reside in TX, MO, KS, OK, AR, MS, LA, IA, NE, WI, NM, or AZ. Graduate of an accredited nursing school or bachelor's degree with 2–4 years related experience; master's in a behavioral health field preferred. Direct experience with IOP, SUD detox, SUD residential, partial hospitalization, or managed care settings. Prior UR/UM experience in behavioral health preferred. Pay: $27.02–$48.55/hour.