Kentucky Licensed Utilization Review Clinician
Job Summary
To support the Kentucky Market, the full-time remote Kentucky Licensed Utilization Review Clinician will perform clinical reviews and assess care related to mental health and substance abuse, ensuring services are medically appropriate through inpatient behavioral health precertification reviews.
Key responsibilities:
- Evaluates treatment for mental health and substance abuse to ensure medical appropriateness before, during, and after services
- Performs prior authorization and concurrent reviews of behavioral health inpatient services, analyzing member data for quality improvement
- Educates providers, members, and families regarding the behavioral health utilization process and collaborates with healthcare teams to enhance care quality
Required qualifications:
- 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
- Licensure as LCSW, LMHC, LPC, LMFT, LMHP, or RN is mandatory
- Clinical knowledge of mental health and substance abuse treatment plans is preferred
- Experience working with healthcare providers in the mental health and substance abuse fields is preferred
Complete Job Description
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