Utilization Review Clinician – Behavioral Health

About the role

The Utilization Review Clinician – Behavioral Health will evaluate mental health and substance‑abuse services to ensure they are medically appropriate and aligned with regulatory criteria. Working fully remote, you will support members, providers, and internal teams across the United States.

Key responsibilities

• Review and authorize mental health and substance‑abuse treatment plans before, during, and after care delivery.
• Conduct concurrent inpatient reviews to assess health status, treatment needs, and discharge planning.
• Analyze utilization data to improve quality, efficiency, and appropriate use of services.
• Provide education to providers, members, and families about the utilization process.
• Collaborate with healthcare providers, medical directors, and leadership to discuss level of care and drive quality improvements.
• Present cases during staffing meetings and integrated rounds.
• Participate in a rotating weekend schedule (approximately every seventh weekend).

Required profile

• Graduate degree in Nursing, Social Work, Counseling, or related field (Master’s required for behavioral health clinicians).
• 2–4 years of experience in behavioral health utilization review or related clinical setting.
• Active state licensure (LCSW, LMHC, LPC, LMFT, LMHP, or RN) appropriate to the role.
• Strong knowledge of mental health and substance‑abuse utilization review processes and regulatory guidelines.

Required skills

What we offer

• Competitive hourly rate ranging from $27.02 to $48.55.
• Fully remote work with a consistent Monday‑Friday schedule (9 AM‑6 PM ET).
• Opportunities to influence care quality and access for millions of members.