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, regulatory compliance, data analysis for quality improvement, provider education, case formulation for staffing rounds
Preferred skills
Master's degree in behavioral health, experience reviewing care services, knowledge of mental health/substance abuse treatment
Technologies
None stated
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; interact with healthcare providers to discuss care levels; engage with medical directors to improve care quality and efficiency; present cases in staffing and integrated rounds
Seniority
Mid-level, hands-on IC