Utilization Review Clinician - Behavioral Health - Remote TX
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Mental Health Referral Services and Crisis Call Center Environment Required Hours: 11:30 am - 8:00 pm (CST)/ 9:30 am - 6:00 pm (PST) Days: Monday - Friday, and required to work some holidays Must have an active and reputed company unrestricted license: LCSW, LPC, LMFT, or LPCC for the state of Texas or California. Position Purpose: Performs a clinical review and assesses care reputed company to mental health and substance abuse. Monitors and determines if level of care and services reputed company to mental health and substance abuse are medically appropriate. Evaluates members treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews reputed company to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs reputed company review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH reputed company providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated reputed company Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: Master's degree in Clinical Counseling, Psychology, Social Work, or reputed company-field AND one of the required licenses/certifications listed, or a Graduate of an Accredited School Nursing or Bachelor's degree and 2 4 years of reputed company experience. Preferred Experience: Prior managed care experience preferred. Prior experience with multiple system applications and electronic data entry, including call center and/or health care databases preferred. Clinical knowledge and ability to review and/or assess treatment plans reputed company to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and reputed company teams to review care services reputed company to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $26.50 - $47.59 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!