Offer summary

Qualifications:

Active, unrestricted clinical license in Washington State (LICSW, LMHC, LMFT, or Psychiatric RN)., 2–4+ years of clinical experience in behavioral health or utilization management., Strong knowledge of medical necessity guidelines and familiarity with NCQA and HIPAA compliance., Excellent written, verbal, and time management skills, along with proficiency in Microsoft Office and EMR systems..

Key responsibilities:

Conduct utilization reviews for inpatient and behavioral health levels of care.

Process concurrent and prior authorizations in compliance with organizational policies.

Collaborate across internal departments to ensure coordinated care and monitor productivity.

Communicate with providers and internal teams, and participate in staff meetings and performance improvement efforts.

Job description

Utilization Management Clinician – Behavioral Health (Remote)

Pay: $45/hour + Full Medical Benefits

Schedule: Monday–Friday, 9:00am–5:00pm PST (or Tuesday–Saturday)

Employment Type: Long-Term Contract

Location: Remote – Must be licensed in Washington State

About The Opportunity

A nationally recognized healthcare organization is seeking a Behavioral Health Utilization Management Clinician to join its high-performing team. This is a 100% remote opportunity supporting members in Washington State. You’ll be a key member of the Utilization Management team, ensuring appropriate, cost-effective, and quality care for behavioral health services through clinical review, coordination, and prior authorizations.

Key Responsibilities

Conduct utilization reviews for inpatient and behavioral health levels of care
Process concurrent and prior authorizations in compliance with organizational policies
Review member eligibility and benefits to determine appropriate level of care
Collaborate across internal departments (Behavioral Health, Long-Term Care, etc.) to ensure coordinated care
Monitor productivity and quality benchmarks while maintaining accurate documentation in EMR systems
Communicate with providers and internal teams professionally and efficiently
Participate in staff meetings, training, performance improvement efforts, and audits
Refer complex cases to medical directors as appropriate

Required Qualifications

Active, unrestricted clinical license in Washington State:

LICSW, LMHC, LMFT, or Psychiatric RN (RN/LPN)

2–4+ years of clinical experience in behavioral health, utilization management, case management, or hospital settings
Strong knowledge of medical necessity guidelines, including InterQual
Familiarity with NCQA and HIPAA compliance
Excellent written, verbal, and time management skills
Proficiency with Microsoft Office and EMR systems
Reliable high-speed internet and access to a home office setup including monitor and docking station

Preferred Experience