Utilization Management Clinician Behavioral Health - Precertification

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Behavioral Health Precertification / Utilization Management Clinician

100% Remote | Monday–Friday | 12:00 PM – 8:30 PM EST

Are you a licensed Behavioral Health professional or Psychiatric RN with Utilization Management experience? Join our team and play a critical role in reviewing behavioral health authorization requests, supporting appropriate levels of care, and ensuring members receive timely, evidence-based treatment.

What You'll Do

As a Behavioral Health Precertification/UM Clinician, you will review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care, with a primary focus on:

Key responsibilities include

Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity

Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions

Utilize Medicare coverage criteria and requirements when applicable

Document determinations, rationale, and recommendations accurately and thoroughly

Coordinate with facilities and providers to obtain additional clinical information when needed

Support discharge planning and transitions of care

Communicate authorization decisions and next steps to providers and internal stakeholders

Identify members who may benefit from additional clinical programs, services, or care management support

Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation

Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

WHAT YOU BRING - REQUIRED

Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as: LMSW

OR

Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience

Additionally, candidates must have

1+ year of Behavioral Health Utilization Review or Utilization Management experience

3+ years of inpatient behavioral health experience in a hospital setting

Recent behavioral health experience or continuous behavioral health-focused work history

Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST

Strong clinical decision-making and medical necessity review skills

Behavioral Health Clinicians

Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

Registered Nurses

Associate Degree in Nursing (ADN) with Behavioral Health experience

Bachelor of Science in Nursing (BSN)

Why Join Us?