Utilization Review Clinician/Advocate needed for remote Per Diem position. The Utilization Review Clinician/Advocate provides telephonic care review and authorization determinations for psychiatric, and substance use treatment services, including prospective, concurrent, and discharge reviews. This role evaluates appropriate levels of care based on medical necessity criteria, collaborates with treatment teams and Physician Advisors regarding authorization decisions and alternative treatment options, and provides members and providers with information on behavioral health benefits and community resources. |