About This Role
This fully remote role involves performing clinical reviews and assessing care related to mental health and substance abuse. The clinician monitors and determines if the level of care and services are medically appropriate, supporting the California market.
Responsibilities
- Evaluate member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
- Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
- Perform concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
- Analyze BH member data to improve quality and appropriate utilization of services
- Provide education to providers, members, and their families regarding BH utilization process
- Interact with BH healthcare providers as appropriate to discuss level of care and/or services
- Engage with medical directors and leadership to improve the quality and efficiency of care
- Formulate and present cases in staffing and integrated rounds
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
- Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience
- License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required
- Master’s degree for behavioral health clinicians
- LCSW - License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Nice to have:
- Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse
- Knowledge of mental health and substance abuse utilization review process
- Experience working with providers and healthcare teams to review care services related to mental health and substance abuse
- Behavioral health and utilization management or review experience
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
Important Details
- Schedule: Monday through Friday, 9-6 pm or 9:30am - 6pm pacific time zone (depending on lunch) with rotating holidays and occasional overtime