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