Utilization Review Nurse

To support Oregon Medicaid, the full-time Oregon Licensed Utilization Review Clinician will conduct clinical reviews and assessments related to mental health and substance abuse services, ensuring medical appropriateness for both inpatient and outpatient care in a fully remote setting. Key responsibilities Evaluates member treatment for mental health and substance abuse to ensure appropriateness of care Performs prior authorization reviews and concurrent reviews of behavioral health inpatient services Analyzes behavioral health data to improve service quality and utilization Required qualifications Master's degree in a relevant field required Independent clinical licensure (LCSW, LMHC, LPC, LMFT, LMHP, or RN) required 2-4 years of experience in behavioral health and utilization management or review Clinical knowledge of mental health and substance abuse treatment plans preferred Experience working with healthcare providers in behavioral health settings preferred