California or Texas Licensed Utilization Review Clinician

Job Summary

A company is looking for a Utilization Review Clinician - Behavioral Health.

Key Responsibilities

• Evaluates member's treatment for mental health and substance abuse to ensure appropriateness of care
• Performs prior authorization reviews for mental health and substance abuse services in line with regulatory guidelines
• Conducts concurrent reviews of behavioral health inpatient cases to assess treatment needs and discharge planning

Required Qualifications, Training, and Education

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience
• Master's degree for behavioral health clinicians is required
• Active, unrestricted clinical license in California or Texas is required
• Clinical knowledge related to mental health and substance abuse treatment plans is preferred
• Experience working with healthcare providers in mental health and substance abuse services is preferred