Tennessee Licensed Utilization Review Clinician

A company is looking for a Utilization Review Clinician - Behavioral Health.

Key Responsibilities

Evaluate member's treatment for mental health and substance abuse to ensure medical appropriateness

Perform prior authorization reviews for mental health and substance abuse services in accordance with regulatory guidelines

Analyze behavioral health member data to enhance service quality and appropriate utilization

Required Qualifications, Training, and Education

Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience

Current state licensure as a Registered Nurse or licensed clinician

Master's degree required for behavioral health clinicians

Preferred clinical knowledge in reviewing treatment plans for mental health and substance abuse

Experience working with healthcare teams in behavioral health services preferred