For our client, we are seeking a Utilization Management Clinical Consultant to join the team of a leader in the Healthcare space.
This remote role will focus on clinical utilization management for behavioral health members, with an emphasis on evaluating medical necessity, supporting appropriate care decisions, and helping guide effective treatment and discharge planning. The consultant will partner with internal teams, external providers, and other stakeholders to coordinate benefit management activities and support access to the right level of care.
Location: Remote - US based candidates only, no visa sponsorship available
Compensation: $108,000 – $155,000 annually
Responsibilities
Coordinate, document, and communicate all aspects of the utilization and benefit management program
Apply critical thinking and medical necessity criteria for child and adolescent care
Consult with internal and external parties regarding utilization management
Gather clinical information to render coverage recommendations and discharge planning
Evaluate and facilitate appropriate healthcare services for members, including urgent interventions
Communicate with providers to ensure optimal care and treatment
Identify and refer members to care management programs
Qualifications
2+ years of experience in a clinical behavioral health setting with a focus on utilization management
Active Arizona clinical and/or counseling license, such as RN, LPC, LAC, LMFT, LMSW, or LCSW
Availability to work Monday-Friday, 8am-5pm, with occasional weekends and holidays
Willingness to travel up to 10% within Phoenix, AZ
Benefits
Comprehensive medical, dental, and vision coverage
Paid time off to support work-life balance
Retirement savings options for future financial security
Access to wellness programs to promote overall well-being
Additional resources for employee and family support
Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.