Remote Behavioral Health Utilization Review Clinician II

Walker Healthforce, Inc.; Long Beach (CA); Remote; USD 55,000 - 83,000; Full time

Benefits offered by this job

Weekly pay via Direct Deposit

Medical, Dental & Vision

401k options

Job summary

Walker Healthforce, Inc. is seeking a Care Review Clinician II with 2-4 years of clinical practice to perform inpatient and outpatient behavioral health utilization reviews and support medical necessity decisions.

This is a remote contract role. In this position, you will review cases, complete concurrent reviews and prior authorizations, and collaborate with providers, medical directors, and interdisciplinary care teams while maintaining compliant records.

Qualifications

• Minimum 2-4 years of clinical practice in behavioral health reviews.
• Experience with inpatient and outpatient behavioral health utilization management.
• Active, unrestricted RN, LVN or LPN license in good standing.
• Completion of an accredited Registered Nursing program or equivalent experience.
• Knowledge of InterQual, medical necessity and length-of-stay criteria; NCQA regulations.

Responsibilities

• Review behavioral health cases for inpatient and outpatient utilization management.
• Complete concurrent reviews and prior authorizations, assessing eligibility and benefits.
• Collaborate with providers, medical directors and interdisciplinary care teams.
• Meet quality and productivity expectations and maintain compliant, confidential records.
• Support team meetings and mentoring on projects.

Skills

Nursing license

InterQual knowledge

Medical necessity criteria

MS Office

Communication

Organization

Length of stay criteria

Education

Registered Nursing program completion

Job description

Walker Healthforce, Inc. is seeking a Care Review Clinician II with 2-4 years of clinical practice to perform inpatient and outpatient behavioral health utilization reviews and support medical necessity decisions.

This is a remote contract role. In this position, you will review cases, complete concurrent reviews and prior authorizations, and collaborate with providers, medical directors, and interdisciplinary care teams while maintaining compliant records.