Position Summary
The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child/adolescent members. This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication.

Duties
Primary Duties & 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.

Experience
Essential Qualifications:
Working knowledge of behavioral health terminology, clinical documentation, and utilization management principles.
Strong critical thinking, problem-solving, and decision-making skills.
Ability to evaluate clinical needs while balancing quality, cost, and member-centered care.
Effective communication skills with diverse clinical staff, members, and community partners.
Ability to handle sensitive and confidential information ethically and responsibly.
Digital literacy and ability to function effectively in a virtual, desk-based work environment.
Cultural competence and ability to work with diverse populations and interdisciplinary teams.

Top 3 Skills
1. Behavioral Health Utilization Management
Ability to review clinical information, apply medical necessity guidelines, and make UM decisions (initial, concurrent, and discharge planning).
Includes strong discharge planning skills to support safe, appropriate transitions of care.

2. Clinical Assessment & Critical Thinking
Skilled in evaluating clinical needs, reviewing records, and making sound decisions that balance quality, cost, and member-centered care.
Must have a strong understanding of community behavioral health resources to support referrals and continuity of care.

3. Communication & Coordination
Strong communication skills with providers and internal teams, plus accurate documentation and strong organizational skills.
Ability to coordinate effectively across multiple stakeholders to support timely care and utilization decisions.

Work Environment & Schedule
Primarily sedentary, desk-based role involving extended periods of sitting, talking, and focused review work.
Standard schedule: Monday–Friday, 8:00 AM–5:00 PM Arizona time.
Occasional holiday or weekend coverage required through rotation.

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

Notes:
M-F 8am-5pm AZ time
This is a remote position