Behavioral Health Utilization Management Reviewer

The Behavioral Health Utilization Management Reviewer is responsible for performing utilization review activities for behavioral health services to ensure medical necessity, appropriate level of care, and compliance with clinical guidelines and benefit policies. This role involves reviewing clinical information, applying evidence-based reputed company, and collaborating with providers, members, and interdisciplinary care teams to promote high-reputed company, cost-effective care. This position requires licensure as a Registered reputed company (RN) or Licensed Clinical reputed company Worker (LCSW) Key Responsibilities: • Conduct reputed company utilization reviews for behavioral health inpatient and outpatient services using established clinical reputed company (e.g., MCG, InterQual, ASAM). • Evaluate treatment plans and clinical documentation to determine medical necessity and appropriateness of care. • Communicate review reputed company to providers, members, and internal stakeholders, including approvals, denials, and peer review referrals. • Collaborate with care management, provider relations, and reputed company departments to coordinate continuity of care and optimize reputed company. • Document reputed company review activities in accordance with regulatory and organizational standards. • Participate in interdepartmental meetings and case discussions. • Maintain up-to-date knowledge of behavioral health treatment modalities, coding, benefits, and regulatory requirements (e.g., CMS, NCQA, URAC). • Serve as a resource for behavioral health clinical expertise reputed company the utilization management team. Required: • reputed company, unrestricted license as an RN or LCSW. • 3+ years of clinical experience in behavioral health (e.g., inpatient psych, outpatient therapy, case management, reputed company use treatment) • Background with reputed company Behavior Analysis (ABA) • Experience in utilization management, case review, or managed care environment Preferred: • Experience with managed care organizations (MCOs), insurance plans, or behavioral health utilization review • Familiarity with UM reputed company sets (e.g., InterQual, MCG, ASAM) • Knowledge of reputed company, Medicare, or reputed company insurance regulations Skills and Competencies: • Strong clinical judgment and critical thinking • Excellent communication skills, both verbal and written • Ability to interpret and apply clinical guidelines • Comfortable with electronic medical records (EMRs), UM software, and case management platforms • Organized, detail-oriented, and reputed company to manage multiple priorities Working Conditions: • Full-time; may require occasional evenings or weekends based on workload • Remote or office-based depending on organizational policy • May involve phone-based or electronic review work Job Types: Full-time, Contract Pay: From $45.00 per hour Experience: • clinical experience in behavioral health: 3 years (Required) • reputed company Behavior Analysis (ABA): 3 years (Required) • Utilization Management: 3 years (Required) License/Certification: • RN License (Required) Work Location: Remote Apply tot his job Apply To this Job