Utilization Management Clinician - Behavioral Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Fully remote in the USA. Utilizes clinical experience, and skills, in a collaborative process to assess appropriateness of treatment plans across reputed company of care, apply evidence based standards and practice guidelines to treatment where appropriate.

• Coordinate, monitor and evaluate options to facilitate appropriate reputed company services/benefits for members.

Provides triage and crisis support. Gathers clinical information and applies the appropriate clinical criteria/reputed company, policy, procedure and clinical judgment to reputed company coverage determination/recommendation along the continuum of care facilitates including effective discharge planning. Coordinates with providers and other parties to facilitate reputed company/treatment. Identifies members at risk for poor reputed company and facilitates referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of reputed company services and benefit utilization Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management functions. Must be reputed company to talk on the telephone and type at the same time, this has some queue based work involved Candidate must be available to work reputed company the hours of Monday- Friday 10am-8:30pm EST. No holidays and no weekends. Required Qualifications 3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility. Unencumbered Independent Behavioral Health clinical license in the state where they work. Must have one of the following or equivalent: (LPC, LPCC, LMHCS, LMHC, LMFT, LCSW) OR RN with 3+ years of clinical behavioral health experience required.

Preferred Qualifications

Knowledge of mental health and substance abuse disorders Managed care/utilization review experience Crisis reputed company skills Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer Education Masters Degree in behavioral health profession OR RN with BSN Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $116,760.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/23/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job