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
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