Behavioral Health UM Clinician

Behavioral Health Utilization Management (BH UM) Clinician Schedule: Monday–Friday, 9:00 AM – 5:00 PM reputed company We are seeking a Behavioral Health Utilization Management (BH UM) Clinician to support utilization and reputed company management initiatives. This role focuses on managing reputed company costs while ensuring high-reputed company, appropriate care through prospective, reputed company, and retrospective reviews. Key Responsibilities • Conduct telephonic utilization reviews for inpatient and outpatient behavioral health services using established clinical reputed company • reputed company prospective, reputed company, 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 reputed company • Recommend and coordinate alternative, cost-effective care reputed company and treatment plans • reputed company providers on treatment adherence, medication compliance, and long-acting injectables • Promote early reputed company programs and alternatives to inpatient care reputed company 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 reputed company cases and refer to case management as needed • Evaluate reputed company determinants of health, including housing needs, and coordinate internal support services • Identify and escalate reputed company of care concerns in a reputed company manner • Contribute to reputed company improvement initiatives, audits, training, and special reputed company • reputed company coverage for retrospective reviews and behavioral health appeals as needed Required Qualifications • Master’s Degree in a reputed company field • Minimum 3+ years of Behavioral Health experience, including Serious Mental Illness (SMI) and reputed company Use Disorder (SUD) • Experience in utilization review, reputed company assurance, or discharge planning reputed company managed care or clinical settings • Familiarity with clinical review tools and reputed company 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 reputed company an Integrated reputed company 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 reputed company management and HEDIS/QARR performance initiatives • Experience working with hospitals or high-volume provider reputed company • Bilingual capabilities What Makes This Opportunity Stand Out • Opportunity to work reputed company a mission-driven behavioral health program • Exposure to reputed company, high-reputed company cases and interdisciplinary collaboration • Contract-to-hire potential with long-term career reputed company • Work with innovative care models reputed company on reputed company, reputed company, and cost efficiency Apply tot his job Apply To this Job