Utilization Review Clinician - Behavioral Health

Location: Remote-GA; preference for applicants residing in the Central or Eastern United States time zones. Schedule: Monday through Friday, 8:00 a.m.–5:00 p.m. Eastern or Central Time.

Salary: $27.02–$48.55 per hour

Company

hirify.global provides healthcare services and supports access to behavioral health and medical care through its Ambetter / Marketplace brand.

What you will do

• Review behavioral health authorizations for inpatient, residential treatment, and partial hospitalization settings.
• Evaluate mental health and substance abuse treatment before, during, and after services to determine medical appropriateness and the appropriate level of care.
• Perform prior authorization and concurrent inpatient reviews in accordance with regulatory guidelines and clinical criteria.
• Analyze member data to improve quality and appropriate utilization of services.
• Educate providers, members, and families about the behavioral health utilization process.
• Discuss care levels and services with providers, medical directors, and leadership; present cases in staffing and integrated rounds.

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 the applicable state-required licensure.
• One of the following required credentials: LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact state licensure.
• Clinical knowledge of mental health and substance abuse treatment planning and utilization review.
• Ability to work Monday through Friday, 8:00 a.m.–5:00 p.m. Eastern or Central Time; preference for applicants in those U.S. time zones.

Culture & Benefits

• 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 consideration of qualified applicants in accordance with applicable law.