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 medical appropriateness
- Performs prior authorization reviews related to mental health and substance abuse in accordance with regulatory guidelines
- Engages with healthcare providers and leadership to improve quality and efficiency of care
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
- License to practice independently or state-required licensure is necessary
- Preferred clinical knowledge in reviewing treatment plans for mental health and substance abuse
- Experience working with healthcare teams in behavioral health is preferred
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