Utilization Review Clinician - Behavioral Health
Core
Performs clinical reviews and assessments of mental health and substance abuse care to determine medical appropriateness of level of care and services.
Role type
Utilization Review Clinician (Behavioral Health)
Builds
Prior authorization decisions, concurrent review determinations, and discharge planning for behavioral health services.
Domain
Healthcare / Behavioral Health / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment of treatment plans, knowledge of mental health and substance abuse regulations, data analysis for service utilization, provider education, case formulation for staffing rounds
Preferred skills
Master's degree in behavioral health, experience with utilization review processes, experience working with healthcare teams
Technologies
None stated
Responsibilities
Evaluate member treatment for mental health and substance abuse, perform prior authorization reviews, perform concurrent reviews of inpatient behavioral health, analyze member data to improve service utilization, provide education to providers and families, interact with healthcare providers regarding level of care, engage with medical directors to improve care quality, formulate and present cases in staffing rounds
Seniority
Mid-level, hands-on IC