Remote Utilization Review Clinician - Behavioral Health

Valley Hope; United States; Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical premiums

Dental & Vision

PTO 27 days

Paid holidays

Parental leave

401k match

Tuition assistance

Student loan support

PSLF eligible employer

HSA & FSA

EAP

Job summary

Valley Hope is seeking an Utilization Review Clinician for a full-time role that can be performed remotely from cities where Valley Hope operates. The position reviews clinical utilization, coordinates with payers, and supports admission decisions within a nationally recognized addiction treatment provider.

The role requires a master’s level licensed clinician or nurse and at least 3 years of behavioral healthcare experience, with preferred 5 years.

Qualifications

• Licensed to practice as a master’s level licensed clinician or nurse in the state of employment.
• Minimum of 3 years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
• Preferred: 5 years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.

Responsibilities

• Review and coordinate clinical utilization and external payer expectations for each patient admission where external payment options exist.
• Serve as a clinical resource for determining admission appropriateness and continued stays.
• Gather required clinical information and report to insurance for authorization of continued stay.
• Maximize certified patient days that are clinically appropriate and available.
• Assist with insurance pre-certifications for admitted patients.
• Appeal denials of certified days when in the best interests of the patient and Valley Hope.
• Communicate patient status with the business office, nursing, and counselor.
• Regularly review medical necessity guidelines for managed care partners.
• Inform staff to assist in discharge planning efforts.
• Complete continuing education credits and adhere to Valley Hope policies.

Skills

Behavioral health counseling

Clinical documentation

Payer coordination

Education

Master’s level licensed clinician or nurse (RN/LPN)

Job description

Valley Hope is seeking an Utilization Review Clinician for a full-time role that can be performed remotely from cities where Valley Hope operates. The position reviews clinical utilization, coordinates with payers, and supports admission decisions within a nationally recognized addiction treatment provider.

The role requires a master’s level licensed clinician or nurse and at least 3 years of behavioral healthcare experience, with preferred 5 years.