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 inpatient services.
Domain
Healthcare / Behavioral Health / Utilization Management
Required skills
Clinical assessment of treatment plans, knowledge of utilization review processes, data analysis for quality improvement, collaboration with multidisciplinary teams, case presentation in staffing rounds, regulatory compliance.
Preferred skills
Experience managing complex behavioral health populations, experience in hospital-based acute care or inpatient psychiatric settings, knowledge of mental health and substance abuse treatment.
Technologies
Electronic Health Records (EHR), Utilization Management software, Data analysis tools.
Responsibilities
Evaluate member treatment before, during, and after services; perform prior authorization and concurrent reviews; analyze member data to improve service utilization; educate providers and families on utilization processes; interact with healthcare providers regarding level of care; engage with medical directors to improve care quality and efficiency.
Seniority
Mid-level, hands-on IC