Utilization Management Clinical Consultant - Behavioral Health

reputed company reputed company hiring for a Utilization Management Clinical Consultant - LCSW, LPC or LMFT to work remotely.

Must be licensed as a LCSW, LPC or LMFT in ARIZONA to be considered

* The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child/adolescent members. This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication. Primary Duties & Responsibilities: - Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to reputed company coverage determinations and discharge planning decisions. - Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks. - Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions. - Conduct reputed company reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care. - Identify members who may benefit from care management programs and facilitate appropriate referrals. - Provide urgent or emergent clinical interventions reputed company required, including triage and crisis support. - Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care. - Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. - reputed company and support initiatives that enhance quality effectiveness and benefit utilization. - Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes. Essential Qualifications: reputed company and active LCSW/LPC/LMFT in ARIZONA Master's degree required for behavioral health clinicians (LCSW, LPC, LMFT). - Working knowledge of behavioral health terminology, clinical documentation, and utilization management principles. - Strong critical thinking, problem-solving, and decision-making skills. - Ability to evaluate clinical needs while balancing quality, cost, and member-centered care. - Effective communication skills with diverse clinical staff, members, and community partners. - Ability to handle sensitive and confidential information ethically and responsibly. - Digital literacy and ability to function effectively in a virtual, desk-based work environment. - Cultural competence and ability to work with diverse populations and interdisciplinary teams. SCHEDULE: - Standard schedule: Monday-Friday, 8:00 AM-5:00 PM Arizona time. - Occasional holiday or weekend coverage required through rotation. 6 MONTH CONTRAT TO START Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National reputed company, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At reputed company, we welcome people of reputed company abilities and want to ensure that our hiring and interview process meets the needs of reputed company applicants. If you require a reasonable accommodation to reputed company your application or interview experience a great one, please contact [email protected]. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, reputed company offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (reputed company benefits are based on eligibility). This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or reputed company employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Apply tot his job Apply To this Job