Job Description
Behavioral Health Utilization Management (BH UM) Clinician
Schedule: Monday–Friday, 9:00 AM – 5:00 PM
Overview
We are seeking a Behavioral Health Utilization Management (BH UM) Clinician to support utilization and quality management initiatives. This role focuses on managing healthcare costs while ensuring high-quality, appropriate care through prospective, concurrent, and retrospective reviews.
- Key Responsibilities
- Conduct telephonic utilization reviews for inpatient and outpatient behavioral health services using established clinical criteria
- Perform prospective, concurrent, and retrospective reviews to determine medical necessity and appropriate level of care
- Collect, evaluate, and document clinical information in the electronic health record system
- Communicate with physicians and provider teams to obtain necessary clinical details
- Collaborate with the Medical Director on cases not meeting medical necessity or level of care criteria
- Recommend and coordinate alternative, cost-effective care options and treatment plans
- Educate providers on treatment adherence, medication compliance, and long-acting injectables
- Promote early intervention programs and alternatives to inpatient care when appropriate
- Participate in interdisciplinary care team meetings for high-risk or high-utilizing members
- Support discharge planning and continuity of care for inpatient populations
- Identify high-risk or complex cases and refer to case management as needed
- Evaluate social determinants of health, including housing needs, and coordinate internal support services
- Identify and escalate quality of care concerns in a timely manner
- Contribute to quality improvement initiatives, audits, training, and special projects
- Provide coverage for retrospective reviews and behavioral health appeals as needed
- Required Qualifications
- Master’s Degree in a related field
- Minimum 3+ years of Behavioral Health experience, including Serious Mental Illness (SMI) and Substance Use Disorder (SUD)
- Experience in utilization review, quality assurance, or discharge planning within managed care or clinical settings
- Familiarity with clinical review tools and criteria sets (e.g., InterQual, LOCADTR)
- Experience working in inpatient and/or outpatient psychiatric settings
- Strong communication and collaboration skills with providers and interdisciplinary teams
- Preferred Qualifications
- Experience within an Integrated Collaborative Care Model
- Knowledge of chronic condition management (e.g., diabetes, HIV, heart disease)
- Familiarity with systems/tools such as Psyckes, ePACES, MAPP, HCS (UAS)
- Background in quality management and HEDIS/QARR performance initiatives
- Experience working with hospitals or high-volume provider groups
- Bilingual capabilities
- What Makes This Opportunity Stand Out
- Opportunity to work within a mission-driven behavioral health program
- Exposure to complex, high-impact cases and interdisciplinary collaboration
- Contract-to-hire potential with long-term career growth
- Work with innovative care models focused on quality, outcomes, and cost efficiency
Apply tot his job
Apply To this Job