California Licensed Utilization Review Clinician
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Job Summary
To support the California market, the full-time California Licensed Utilization Review Clinician will perform clinical reviews and assessments related to mental health and substance abuse, ensuring the medical appropriateness of care and services while working remotely.
Key responsibilities
- Evaluates treatment for mental health and substance abuse to ensure appropriate levels of care
- Conducts prior authorization and concurrent reviews to determine medical necessity in accordance with regulatory guidelines
- Analyzes behavioral health data to enhance service quality and utilization, while providing education to members and providers
Required qualifications
- Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience
- Master's degree required for behavioral health clinicians
- State licensure as LCSW, LMHC, LPC, LMFT, LMHP, or RN required
- Preferred experience in behavioral health and utilization management
- Clinical knowledge of mental health and substance abuse treatment plans preferred
Complete Job Description
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