Utilization Review Clinician – Behavioral Health

About the role

The Utilization Review Clinician conducts clinical reviews of mental health and substance‑abuse services to ensure medical appropriateness. This fully remote position supports Ambetter/Marketplace authorizations for inpatient, residential, and partial‑hospitalization settings.

Key responsibilities

• Evaluate members’ treatment before, during, and after services to confirm appropriate level of care.
• Perform prior‑authorization and concurrent reviews in line with regulatory criteria.
• Analyze behavioral‑health data to improve quality and utilization.
• Provide education to providers, members, and families about the utilization process.
• Collaborate with healthcare providers and medical directors on discharge planning and care efficiency.
• Present cases during staffing and integrated rounds.

Required profile

• Graduate of an accredited nursing program or bachelor’s degree with 2–4 years related experience.
• Relevant licensure (LCSW, LMHC, LPC, LMFT, LMHP, or RN) and state‑required practice authority.
• Master’s degree in behavioral health preferred.
• Knowledge of mental‑health and substance‑abuse utilization‑review processes.

What we offer

• Competitive hourly pay ranging from $27.02 to $48.55.
• Comprehensive health insurance, 401(k) and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible remote work schedule (Monday‑Friday, 8‑5 ET/CT).