Utilization Management Clinician – Behavioral Health (Remote)

Job Title: Utilization Management Clinician – Behavioral Health (Remote) Location Requirements: Candidates must reside in one of the following states: Arizona (AZ), Florida (FL), Georgia (GA), Idaho (ID), Iowa (IA), Kentucky (KY), Michigan (MI), Nebraska (NE), New Mexico (NM), New York (NY – outside greater NYC), Ohio (OH), Texas (TX), Utah (UT), Washington (WA), or Wisconsin (WI). Licensure must be in Washington (WA), regardless of physical location. Time Zone Requirements: Pacific Standard Time (PST) hours required. Work Schedule: Monday–Friday or Tuesday–Saturday, 9:00 AM – 5:00 PM PST Position Type: Temporary to Permanent Compensation: Up to $45 per hour Remote Work: 100% Remote Required Equipment: In addition to a laptop, keyboard, mouse, and headset, candidates will need a monitor and docking station. Position Summary: A Managed Care Organization is seeking a Behavioral Health Utilization Management Clinician to support the review of inpatient and outpatient services, ensuring appropriate care and resource utilization. This role involves evaluating prior authorization requests and conducting concurrent reviews to determine medical necessity for behavioral health services.

Process utilization review cases across various levels of care Conduct prior authorization and concurrent reviews for behavioral health services Determine eligibility, benefits, and expected length of stay Collaborate with interdisciplinary teams to promote continuity of care Refer cases to medical directors as appropriate Maintain productivity and quality performance standards Participate in team meetings and contribute to onboarding of new clinicians Adhere to regulatory guidelines, organizational policies, and HIPAA compliance