California Licensed Utilization Review Clinician

Job Summary

To support the California Market, the full-time California Licensed Utilization Review Clinician will perform clinical reviews and assess care related to mental health and substance abuse while working remotely, with a schedule of Monday through Friday from 9 am to 6 pm or 9:30 am to 6 pm Pacific Time.

Key responsibilities:

• Evaluates treatment for mental health and substance abuse to ensure medical appropriateness of care levels and services
• Conducts prior authorization reviews and concurrent reviews for behavioral health inpatient services
• Analyzes member data to enhance service quality and utilization, while providing education to providers and families on the utilization process

Required qualifications:

• Graduate of an accredited nursing school or bachelor's degree with 2-4 years of related experience
• Master's degree for behavioral health clinicians is required
• California state licensure as an LCSW, LMHC, LPC, LMFT, LMHP, or RN is required
• Clinical knowledge of mental health and substance abuse treatment plans is preferred
• Experience in behavioral health utilization review processes and working with healthcare providers is preferred