Utilization Management Behavioral Health Professional
New
United StatesFull-TimeMiddle
Salary65,000 - 88,600 USD per year
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Job Details
- Experience
- Minimum 1 year of post-degree clinical experience in a behavioral health or direct patient care setting; 1 year of experience in managed care or utilization review processes.
- Required Skills
- Microsoft Office
Requirements
- Active, unrestricted license as an RN, LCSW, LPC, LMFT, LCP, or Clinical Psychologist, valid in Virginia or eligible under compact licensure.
- Minimum 1 year of post-degree clinical experience in a behavioral health or direct patient care setting.
- At least 1 year of experience in managed care or utilization review processes.
- Strong knowledge of behavioral health conditions, including inpatient psychiatry, substance use, or related treatment settings.
- Proficiency with Microsoft Office tools.
- Ability to navigate multiple digital systems in a remote environment.
- Strong communication, problem-solving, and interpersonal skills.
Responsibilities
- Conduct utilization management reviews by applying clinical guidelines, policies, and behavioral health expertise to determine appropriate levels of care.
- Coordinate with providers, members, and internal teams to support care decisions, treatment planning, and benefit determinations.
- Document and communicate clinical decisions clearly, ensuring accuracy, compliance, and consistency with organizational standards.
- Interpret complex cases and make independent decisions within established frameworks while escalating when necessary.
- Collaborate with multidisciplinary teams to support care coordination, case management, and member engagement.
- Participate in quality improvement initiatives and contribute to process efficiency and best practice development.
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