Behavioral Health Utilization Manager

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Evaluate prior authorization requests for outpatient behavioral health services.

• Confirm medical necessity and ensure adherence to clinical guidelines and health plan stipulations.

• Collaborate with healthcare providers and interdisciplinary teams to facilitate timely care decisions.

• Oversee individual members throughout the entire healthcare continuum.

• Review and authorize behavioral health and substance use services in inpatient, residential, and outpatient environments.

• Monitor care to verify that treatment remains suitable and effective.

• Assess, create, implement, oversee, and document member care plans and resource usage.

• Facilitate options and services to address members’ healthcare needs.

• Provide telephonic or electronic review of documents.

• Engage with internal and external resources for effective care planning and discharge strategies.

• Monitor quality-of-care issues.

• Regularly consult with medical directors.

• Offer education and suggest alternative care plans when treatment fails to meet medical necessity standards.

• Conduct prior authorization, concurrent, retrospective, and appeal assessments.

• Lead initiatives for process improvements within patient populations.

• Assess medical necessity and the appropriateness of care.

• Build collaborative relationships with physicians, payers, and interdisciplinary healthcare teams.

• Gather and communicate relevant information for utilization and regulatory compliance.

• Develop and manage interdisciplinary plans for patient discharges.

• Educate internal healthcare team members on case management and managed care principles.

⛳️ Requirements

• A master’s degree in social work, counseling, or a related field, or independent or associate licensure is required.

• Licensure in at least one of the following areas as mandated by state law: social work, professional counseling, or marriage and family therapy.

• Applicable licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.

• A minimum of three years of clinical experience in counseling, care management, case management, or care coordination in inpatient or outpatient settings.

• Proficient understanding of care management, case management, and hospital and community resources.

• Strong critical thinking, problem-solving, effective communication, and time management abilities.

• Capability to work effectively both independently and within an interdisciplinary team.

• Arizona residency is required for compliance purposes.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Retirement savings plan with employer matching.

• Professional development opportunities and training.

• Flexible work environment and schedules.