Back to Career Site

Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.

The Utilization Management Clinician uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate mental health, behavioral health and substance abuse treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. This role makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed while following established guidelines/procedures.

• Provides first level clinical review for all mental health, behavioral health and substance abuse authorization requests against applicable criteria, policies and procedures. Accurately documents all reviews and contacts providers and members according to established timeframes.
• Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care delivery team to maintain high quality and cost-effective care delivery.
• Screening and coordination of cases within the utilization management department and other Bright clinical teams including Case Management, Care Navigation and Transitions of Care to ensure optimal care for members
• Escalates all potential quality issues and grievances to correct, Bright workflows
• Hours would not exceed 30 per week, Mandatory Saturday and Sunday shifts

• Graduate of Nursing program required; BSN desired or Graduate in Clinical Psychology or Clinical Social Work.
• Experience working with behavioral health cases.
• Active clinical licensure in good standing with current state
• 3+ years of utilization management/quality improvement experience on the Payer side
• Working knowledge and understanding of basic utilization management concepts.

• Experience interpreting clinical criteria into clear determinations.
• Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities.
• Excellent writing skills, particularly in determination notification writing.
• Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative environment.
• Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.

• Active clinical licensure in good standing with current state