Job Title: Utilization Management Clinician – Behavioral Health (Remote)

Location Requirements:
Candidates must reside in one of the following states: Arizona (AZ), Florida (FL), Georgia (GA), Idaho (ID), Iowa (IA), Kentucky (KY), Michigan (MI), Nebraska (NE), New Mexico (NM), New York (NY – outside greater NYC), Ohio (OH), Texas (TX), Utah (UT), Washington (WA), or Wisconsin (WI).

Licensure must be in Washington (WA), regardless of physical location.

Time Zone Requirements:
Pacific Standard Time (PST) hours required.

Work Schedule:
Monday–Friday or Tuesday–Saturday, 9:00 AM – 5:00 PM PST

Position Type:
Temporary to Permanent

Compensation:
Up to $45 per hour

Remote Work:
100% Remote

Required Equipment:
In addition to a laptop, keyboard, mouse, and headset, candidates will need a monitor and docking station.

Position Summary:
A Managed Care Organization is seeking a Behavioral Health Utilization Management Clinician to support the review of inpatient and outpatient services, ensuring appropriate care and resource utilization. This role involves evaluating prior authorization requests and conducting concurrent reviews to determine medical necessity for behavioral health services.

Day-to-Day Responsibilities:

• Process utilization review cases across various levels of care

• Conduct prior authorization and concurrent reviews for behavioral health services

• Determine eligibility, benefits, and expected length of stay

• Collaborate with interdisciplinary teams to promote continuity of care

• Refer cases to medical directors as appropriate

• Maintain productivity and quality performance standards

• Participate in team meetings and contribute to onboarding of new clinicians

• Adhere to regulatory guidelines, organizational policies, and HIPAA compliance

Must-Have Requirements:

• Behavioral Health background

• Utilization Management experience

• Licensure in the state of Washington as one of the following:

  • Licensed Independent Clinical Social Worker (LICSW)

  • Licensed Professional Clinical Counselor (LPCC)

  • Licensed Mental Health Counselor (LMHC)

  • Marriage and Family Therapist (LMFT)

  • Psychiatric Nurse

  • Registered Nurse (RN)

Preferred Experience:

• 2–4 years of clinical experience, ideally in hospital settings, utilization review, or case management

• Familiarity with InterQual criteria and NCQA standards

• Previous work within a managed care or health plan environment

Knowledge, Skills, and Abilities:

• Excellent communication, critical thinking, and decision-making skills

• Ability to manage multiple priorities and work independently

• Knowledge of federal/state regulations and behavioral health utilization review protocols

• Proficiency with Microsoft Office and electronic medical record systems

• Commitment to ethical standards and professional conduct