Behavioral Health Utilization Review Clinician

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The Behavioral Health Utilization Review nurse will perform authorizations and review of utilization as it relates to mental health and substance abuse services within outpatient, inpatient and intermediate care settings.

This is a remote/home based role. Readily hiring from the following areas: WA, OR, MT, ID, AK, and TX.

What you will do:

• Consults with Medical Directors when care does not meet applicable criteria or medical policies.
• Documents clinical information completely, accurately, and in a timely manner.
• Maintains a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria including Milliman Care Guidelines and medical policy.
• Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g. case management, engagement team, and disease management).
• Maintains a thorough understanding of accreditation and regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards are within compliance.
• Supports the Plan's Quality Program: Identifies and participates in quality improvement activities as it relates to internal programs, processes studies and projects.

What you'll bring:

• Bachelor's degree or four (4) years' work experience.
• Current State Licensure as a registered nurse or behavioral health clinician where licensing is required by State law.
• Three (3) years of clinical experience.

Preferred Qualifications:
• Utilization Management experience.
• Experience working in the health plan industry.

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What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.