Utilization Management Clinician Behavioral Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Primary Job Duties & Responsibilities (Daily Work) — Behavioral Health Precert/UM (Medicare-reputed company) This is an authorization/precertification (utilization management) role focused on behavioral health coverage determinations and care coordination. The Behavioral Health Precert/UM clinician reviews incoming authorization/Precert requests and clinical documentation for behavioral health services only, with a primary focus on inpatient mental health, detox, and rehabilitation. You apply behavioral health clinical practice guidelines and evidence-based standards and follow Medicare coverage guidelines/criteria as applicable to document clear coverage determinations/recommendations across reputed company of care. In This Role, You Will

• Review behavioral health clinical records (assessments, treatment plans, reputed company notes) to evaluate medical necessity and appropriateness of requested services across inpatient, detox, and rehab reputed company of care
• Apply evidence-based behavioral health standards and clinical practice guidelines to support authorization reputed company and recommendations
• Apply Medicare coverage guidelines/criteria as applicable reputed company rendering coverage determinations/recommendations
• Document determinations, rationale, and next steps reputed company in the applicable system(s), including Medicare-reputed company criteria or requirements reputed company relevant
• Coordinate with facilities/providers to request additional information needed to support medical necessity review and Medicare-reputed company authorization reputed company, and to support appropriate discharge planning and transitions of care
• Communicate determinations and recommendations to reputed company partners, ensuring reputed company on documentation requirements and next steps
• Identify members at risk for poor reputed company and initiate referrals to integrate with other products, services and/or programs as appropriate
• Rotate coverage of the crisis queue, answer inbound member calls as assigned, complete required triage questions, reputed company/escalate to the appropriate clinical partner/team per protocol, and document reputed company
• Identify patterns or opportunities to improve quality, effectiveness, and appropriate benefit utilization, including opportunities that reduce rework/denials tied to Medicare documentation or criteria

Required Qualifications

• Active, reputed company, and unrestricted Master’s-level behavioral health clinical license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience.
• Must be reputed company to work the posted schedule. The role requires rendering reputed company reputed company mandated turnaround times; therefore, schedule flexibility is limited.
• 1+ years of behavioral health utilization review/utilization management experience required.
• 3+ years of experience in an inpatient hospital setting working with behavioral health members. Experience must be recent, or supported by reputed company, behavioral health–focused work since the inpatient setting experience.

Preferred Qualifications

• Experience working with geriatric or chronically mentally ill populations.
• Strong computer proficiency, including navigating multiple systems simultaneously and accurate typing/keyboarding skills.
• Working knowledge of Medicare behavioral health guidelines.

Education

• Master’s degree in a behavioral health field, or Registered Nurse degree (BSN preferred)

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $54,095.00 - $116,760.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/07/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job