Utilization Review Clinician - Behavioral Health

About the role

The Utilization Review Clinician – Behavioral Health provides clinical oversight of mental health and substance‑use services, ensuring that care levels and treatments are medically appropriate. Working fully remotely for Partnerships In Care, you will support utilization management and quality improvement across a national network of providers.

Key responsibilities

• Conduct prior‑authorization, concurrent, and retrospective reviews of behavioral health services to verify medical necessity.
• Analyze member data to identify outlier performance and recommend improvements.
• Prepare and deliver clear, actionable presentations for providers, health‑plan leadership, and medical directors.
• Collaborate with clinicians, providers, and families to explain utilization processes and support discharge planning.
• Document findings in compliance with regulatory guidelines and internal policies.

Required profile

• Independent licensure in behavioral health (e.g., LCSW, LMHC, LCPC, LMFT).
• 2–4 years of experience in mental‑health or substance‑use settings, including outpatient or residential care.
• Experience with utilization management or clinical review processes.
• Strong presentation skills and ability to coach providers on performance.

Required skills

• Clinical assessment of mental‑health and substance‑use treatment plans.
• Knowledge of utilization review criteria and regulatory standards.
• Data analysis to support quality and utilization improvements.
• Effective communication with multidisciplinary teams.

What we offer

• Fully remote work with flexible scheduling (Monday‑Friday, 8‑5 am/pm across US time zones).
• Opportunity to influence care quality for a large member population.