Behavioral Health UM Clinician

Behavioral Health Utilization Management (BH UM) ClinicianSchedule: Monday–Friday, 9:00 AM – 5:00 PMOverviewWe 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 ResponsibilitiesConduct telephonic utilization reviews for inpatient and outpatient behavioral health services using established clinical criteriaPerform prospective, concurrent, and retrospective reviews to determine medical necessity and appropriate level of careCollect, evaluate, and document clinical information in the electronic health record systemCommunicate with physicians and provider teams to obtain necessary clinical detailsCollaborate with the Medical Director on cases not meeting medical necessity or level of care criteriaRecommend and coordinate alternative, cost-effective care options and treatment plansEducate providers on treatment adherence, medication compliance, and long-acting injectablesPromote early intervention programs and alternatives to inpatient care when appropriateParticipate in interdisciplinary care team meetings for high-risk or high-utilizing membersSupport discharge planning and continuity of care for inpatient populationsIdentify high-risk or complex cases and refer to case management as neededEvaluate social determinants of health, including housing needs, and coordinate internal support servicesIdentify and escalate quality of care concerns in a timely mannerContribute to quality improvement initiatives, audits, training, and special projectsProvide coverage for retrospective reviews and behavioral health appeals as neededRequired QualificationsMaster's Degree in a related fieldMinimum 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 settingsFamiliarity with clinical review tools and criteria sets (e.g., InterQual, LOCADTR)Experience working in inpatient and/or outpatient psychiatric settingsStrong communication and collaboration skills with providers and interdisciplinary teamsPreferred QualificationsExperience within an Integrated Collaborative Care ModelKnowledge 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 initiativesExperience working with hospitals or high-volume provider groupsBilingual capabilitiesWhat Makes This Opportunity Stand OutOpportunity to work within a mission-driven behavioral health programExposure to complex, high-impact cases and interdisciplinary collaborationContract-to-hire potential with long-term career growthWork with innovative care models focused on quality, outcomes, and cost efficiency