Working remotely on a full-time basis, the State Licensed Utilization Review Clinician will perform clinical reviews and assess care related to mental health and substance abuse, ensuring the appropriateness of services and levels of care while working second shift from 2pm to 10pm EST. Key responsibilities Evaluate member treatment for mental health and substance abuse to ensure medical appropriateness Perform prior authorization reviews in accordance with regulatory guidelines and criteria Analyze behavioral health member data to improve service quality and utilization Required qualifications Graduate of an accredited school of nursing or a bachelor's degree with 2-4 years of related experience Master's degree for behavioral health clinicians required State licensure as a Clinical Social Worker, Mental Health Counselor, Professional Counselor, Marriage and Family Therapist, or Registered Nurse required Clinical knowledge and ability to assess treatment plans related to mental health and substance abuse preferred Experience working with healthcare providers to review mental health care services preferred
Utilization Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.