Utilization Review Clinician – Behavioral Health

About the role

The Utilization Review Clinician (Behavioral Health) conducts clinical reviews of mental health and substance‑abuse services to ensure medical appropriateness and optimal patient outcomes. The role operates on a rotating Thursday‑Sunday or Saturday‑Tuesday schedule, supporting members across Central and Eastern time zones.

Key responsibilities

• Evaluate members’ treatment plans before, during, and after services for medical appropriateness.
• Perform prior‑authorization and concurrent reviews of behavioral health inpatient care.
• Analyze member data to improve quality, utilization, and discharge planning.
• Educate providers, members, and families on the behavioral health utilization process.
• Collaborate with healthcare providers, medical directors, and leadership to enhance care efficiency.
• Formulate and present cases during staffing and integrated rounds.
• Maintain compliance with all policies and standards.

Required profile

• Graduate of an accredited nursing or related program with a Bachelor’s degree.
• 2–4 years of experience in behavioral health utilization review or related clinical setting.
• Master’s degree in behavioral health (required for clinicians).
• Current state licensure (e.g., LCSW, LMHC, LPC, LMFT, LMHP, RN) allowing independent practice.
• Strong clinical knowledge of mental health and substance‑abuse treatment.

Required skills

• Utilization review and prior‑authorization processes.
• Clinical assessment of mental health and substance‑abuse services.
• Data analysis to support quality improvement.

What we offer

• Competitive hourly wage ranging from $27.02 to $48.55.
• Flexible schedule options across two 10‑hour shifts.
• Opportunity to impact the health of members nationwide.