Senior Behavioral Health Utilization Management Clinician

Your Role

Join our dedicated Behavioral Health Utilization Management team, where you will play a vital role in conducting comprehensive prospective and concurrent utilization reviews. As a Senior Behavioral Health Utilization Management Clinician, you will report to the Manager of Behavioral Health Utilization Management (BH UM) and be responsible for evaluating mental health and substance use authorization requests across various levels of care. Your expertise will ensure compliance with established medical necessity criteria, coding standards, and organizational policies.

Your Knowledge and Experience

• Possession of a valid and unrestricted license (LCSW, LMFT, LPCC, PhD/PsyD, or RN with Behavioral Health experience) is required.
• An advanced degree in a relevant field is preferred.
• A minimum of five (5) years of experience in a healthcare-related field is essential.
• At least three (3) years of experience in Behavioral Health Utilization Management within a health insurance plan or managed care environment is required.
• Strong understanding of Behavioral Health Utilization Management practices and the ability to apply and interpret clinical criteria from multiple standardized sets such as MCG guidelines and various Medicare policies.
• Familiarity with medical terminologies, diagnostic classifications, and treatment interventions, with the ability to understand psychiatric evaluations, clinical notes, and lab results.
• Proficient in Microsoft Excel, Outlook, Word, and PowerPoint; capable of quickly learning and adapting to new systems and databases.
• Excellent analytical abilities, as well as strong communication, organizational, and time management skills.
• Possess outstanding interpersonal skills, a positive attitude, and a strong initiative to excel in your role.
• Able to identify challenges and pursue resolutions independently while seeking guidance when necessary.