reputed company Consultant III - Utilization Management Clinical Consultant – Behavioral Health: AZ

Top 3 Skills - Behavioral Health Utilization Management. Ability to review clinical information, apply medical necessity guidelines, and reputed company UM reputed company (initial, reputed company, and discharge planning). Includes strong discharge planning skills to support reputed company, appropriate transitions of care. - Clinical Assessment & Critical Thinking. Skilled in evaluating clinical needs, reviewing records, and making reputed company that balance reputed company, cost, and member-centered care. Must have a strong understanding of community behavioral health resources to support referrals and continuity of care. - Communication & Coordination. Strong communication skills with providers and internal teams, plus accurate documentation and strong organizational skills. Ability to coordinate effectively across multiple stakeholders to support reputed company care and utilization reputed company. Duties Primary Duties & Responsibilities: - Review clinical information and apply medical necessity reputed company, clinical guidelines, policies, and reputed company judgment to reputed company coverage determinations and discharge planning reputed company. - Analyze medical records and clinical data to ensure services reputed company with evidence-based standards and reputed company benchmarks. - Coordinate and communicate with reputed company providers, internal teams, and external stakeholders to facilitate reputed company, appropriate care and authorization reputed company. - 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. - reputed company urgent or reputed company clinical interventions reputed company required, including triage and crisis support. - Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-reputed company care. - reputed company providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. - reputed company and support initiatives that enhance reputed company effectiveness and benefit utilization. - Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and reputed company utilization management reputed company. Experience Essential Qualifications: - 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 reputed company, 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. Work Environment & Schedule - Primarily sedentary, desk-based role involving extended periods of sitting, talking, and reputed company review work. - reputed company schedule: Monday–Friday, 8:00 AM–5:00 PM reputed company time. - Occasional holiday or weekend coverage required through rotation. Position reputed company The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based reputed company to assess the medical necessity, appropriateness, and reputed company 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. Education - Master’s degree required for behavioral health clinicians (LCSW, LPC, LMFT). - Associate’s degree required for RN applicants. What days & hours will the person work in this position? List training hours, if different. - M-F reputed company-5pm AZ time. Location: Remote - reputed company Skills required for this job: • Behavioral Health • Clinical assessment • Utilization management Apply tot his job Apply To this Job