Indiana Licensed Utilization Review Clinician

Job Summary

Supporting the Indiana Behavioral Health Medicaid Plan, the full-time remote Indiana Licensed Utilization Review Clinician will perform medical necessity reviews and authorization determinations to ensure members receive appropriate, high-quality behavioral health services.

Key responsibilities

• Evaluate treatment for mental health and substance abuse to ensure medical appropriateness of care
• Conduct prior authorization and concurrent reviews for behavioral health services in accordance with regulatory guidelines
• Engage with healthcare providers and leadership to improve care quality and efficiency, providing education on the utilization process

Required qualifications

• Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC) in Indiana
• 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
• Preferred experience in behavioral health and/or utilization management
• Strong knowledge of medical necessity criteria and managed care principles