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Virtual Utilization Review, BSW or MSW 

EOE StatementWe are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

This is a full-time, VIRTUAL permanent position for Behavioral Health Utilization Review.

The Clinician will be responsible for authorizing and reviewing utilization of mental health and substance use services provided in inpatient and outpatient care settings; assists with discharge planning and ambulatory follow up activity provides member assistance with mental health and substance use issues, and participates in special utilization projects.

Position Responsibilities:
•Performs telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned.

•Determines appropriate level of care related to mental health and substance use treatment for members based on insurance medical necessity level of care criteria.

•Consults with treatment team when requests for services do not meet medical necessity criteria.

•Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases.

•Provides information to members and providers regarding mental health and substance use benefits and community treatment resources. 

Position Requirements

Experience with UM Behavioral Health and SUD preferred.

Education: Master's Degree 


Relevant Work Experience: Minimum of two (2) years of combined direct behavioral health clinical and managed care experience

Knowledge, Skills & Abilities:
•Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information and facilitate care in multiple settings.

•Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.

•Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.

•Excellent communication skills, both verbal and written.

•Demonstrated ability to relate effectively to behavioral health and medical treatment providers, members and family member and other professionals involved in the treatment of the member.

•Familiarity with and ability to effectively utilize computer technology.


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