Utilization Review Clinician - Behavioral Health

Location: Remote in Texas, United States; fully remote provider-facing role with four 10-hour shifts per week. Saturday availability is required, and availability for both Saturday and Sunday is preferred.

Salary: $27.02–$48.55 per hour

Company

Healthcare organization focused on connecting people with accessible care and improving health outcomes.

What you will do

• Review mental health and substance abuse treatment before, during, and after services to assess medical appropriateness and level of care.
• Perform prior authorization and concurrent reviews for inpatient behavioral health services in accordance with regulatory guidelines and clinical criteria.
• Assess members’ treatment needs, overall health status, and discharge planning requirements.
• Analyze behavioral health utilization data to improve care quality and appropriate service use.
• Educate providers, members, and families about the behavioral health utilization process.
• Present cases in staffing and integrated rounds while collaborating with providers, medical directors, and leadership.

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 practice license or applicable state-required licensure.
• One of the following required credentials: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state or compact-state licensure.
• Clinical knowledge of mental health and substance abuse treatment plans and utilization review processes.
• Saturday availability is required; four 10-hour shifts are scheduled weekly.

Nice to have

• Experience working with providers and healthcare teams to review mental health and substance abuse services.
• Availability to work both Saturdays and Sundays.

Culture & Benefits

• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Shift differential for weekend hours.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Additional compensation may include incentives, subject to eligibility.