Healthcare Consultant III - Utilization Management - Clinical Consultant - Behavioral Health

SGS_JOB_3809

Business Support
Remote
Medicaid
Care Management
Case Management
Utilization Management
Healthcare

Contract - 03+ Months Extendable

Location : Remote (In Arizona) Shift: Monday–Friday, 8:00 AM–5:00 PM Arizona time and Occasional holiday or weekend coverage required through rotation This is a remote position but does require BH licenses, those must be active in Arizona. We likely will not get candidates out of state with an AZ BH license. They can live anywhere in AZ and don’t have to be close to the office

Job Responsibilities:

  • Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.
  • Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks.
  • Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions.
  • Conduct concurrent 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.
  • Provide urgent or emergent clinical interventions when required, including triage and crisis support.
  • Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care.
  • Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
  • Develop and support initiatives that enhance quality effectiveness and benefit utilization.
  • Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.
  • Primarily sedentary, desk-based role involving extended periods of sitting, talking, and focused review work.
  • Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.
  • Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks.
  • Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions.
  • Conduct concurrent 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.
  • Provide urgent or emergent clinical interventions when required, including triage and crisis support.
  • Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care.
  • Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
  • Develop and support initiatives that enhance quality effectiveness and benefit utilization.
  • Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.
  • Primarily sedentary, desk-based role involving extended periods of sitting, talking, and focused review work.

Skills:

  • Medicaid
  • Care Management
  • Case Management
  • Utilization Management
  • Medicaid
  • Care Management
  • Case Management
  • Utilization Management

Education/Experience:

  • Master’s degree required for behavioral health clinicians (LCSW, LPC, LMFT).
  • Associate’s degree required for RN applicants.
  • Master’s degree required for behavioral health clinicians (LCSW, LPC, LMFT).
  • Associate’s degree required for RN applicants.

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