Behavioral Health UM Clinician
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
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