Utilization Review Clinician - Behavioral Health

Location: Remote-KS, United States. Monday through Friday, 8:00 AM–5:00 PM in the Eastern, Central, Mountain, or Pacific time zone.

Salary: $27.02–$48.55 per hour.

Company

hirify.global connects people with healthcare services and supports more accessible and effective care.

What you will do

• Evaluate mental health and substance abuse treatment before, during, and after services to determine medical appropriateness and the appropriate level of care.
• Conduct prior authorization and concurrent reviews for behavioral health services, including inpatient care, treatment needs, and discharge planning.
• Analyze behavioral health member data to improve quality and appropriate utilization of services.
• Educate providers, members, and families about the behavioral health utilization process.
• Discuss levels of care and services with behavioral health providers and collaborate with medical directors and leadership.
• Present cases in staffing and integrated rounds, identify provider performance outliers, and deliver individualized provider coaching.

Requirements

• Graduate of an accredited nursing school or a bachelor's degree with 2–4 years of related experience.
• Master's degree required for behavioral health clinicians.
• Independent state licensure is required, including LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact licensure.
• Clinical knowledge of mental health and substance abuse treatment plans and utilization review processes.
• Experience working with providers and healthcare teams to review behavioral health services.
• Experience with behavioral health settings, utilization management, provider or leadership presentations, and provider performance advising is preferred.

Culture & Benefits

• Fully remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Equal opportunity workplace committed to diversity and inclusion.