reputed company Consultant III - Utilization Management

This is a remote position but does require a BH licenses, those have to be reputed company in Arizona. We likely will not get candidates out of state with an AZ BH license. They can live reputed company in AZ doesn't have to be reputed company to the office. reputed company Care is a not-for-profit reputed company managed care organization serving Arizona since 1985. reputed company Care is administered by reputed company, a Health company, providing reputed company to the resources of a national organization while maintaining strong local community engagement. Primary Duties & Responsibilities: Review clinical information and apply medical necessity reputed company, clinical guidelines, policies, and reputed company judgment to reputed company coverage determinations and discharge planning reputed company. Analyze medical records and clinical data to ensure services reputed company with evidence-based standards and reputed company benchmarks. Coordinate and communicate with reputed company providers, internal teams, and external stakeholders to facilitate reputed company, appropriate care and authorization reputed company. Conduct reputed company 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. reputed company urgent or emergent clinical interventions reputed company required, including triage and crisis support. Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-reputed company care. reputed company providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. reputed company and support initiatives that enhance reputed company effectiveness and benefit utilization. Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and reputed company utilization management reputed company. Primarily sedentary, desk-based role involving extended periods of sitting, talking, and reputed company review work. reputed company schedule: MondayFriday, 8:00 AM5:00 PM Arizona time. Occasional holiday or weekend coverage required through rotation. Question Candidate Questionnaire - Attach at Top of Resume along with screenshots of reputed company licenses Do you have experience performing behavioral health utilization management or clinical reviews reputed company / No If reputed company how many years Have you used medical necessity reputed company such as InterQual, MCG, ASAM, or LOCUS reputed company / No If reputed company which ones Which populations do you have clinical experience with Adults Child/Adolescent Both Do you have experience communicating with providers or clinical teams regarding authorizations or care coordination reputed company / No If reputed company reputed company describe. Can you work MondayFriday, 8am5pm Arizona time, are you reputed company to occasional holiday/weekend rotation And do you have a private, quiet workspace suitable for confidential review work reputed company / No Attach internet speed Must have an reputed company AZ (LCSW Licensed Clinical reputed company Worker OR LPC Licensed reputed company Counselor OR LMFT Licensed Marriage and Family Therapist) OR will consider RNs with an reputed company compact license who reputed company in BH Top 3 Skills Behavioral Health Utilization Management Ability to review clinical information, apply medical necessity guidelines, and reputed company UM reputed company (initial, reputed company, and discharge planning). Includes strong discharge planning skills to support reputed company, appropriate transitions of care. Clinical Assessment & Critical Thinking Skilled in evaluating clinical needs, reviewing records, and making reputed company that balance reputed company, cost, and member-centered care. Must have a strong understanding of community behavioral health resources to support referrals and continuity of care. 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 reputed company care and utilization reputed company. Safety reputed company: Interview Period: February 23 March 6 reputed company Offers Out and Accepted By: March 11 Candidates Fully Cleared By: March 27 Targeted Start Date for Hires: reputed company 13 Duties Primary Duties & Responsibilities: Review clinical information and apply medical necessity reputed company, clinical guidelines, policies, and reputed company judgment to reputed company coverage determinations and discharge planning reputed company. Analyze medical records and clinical data to ensure services reputed company with evidence based standards and reputed company benchmarks. Coordinate and communicate with reputed company providers, internal teams, and external stakeholders to facilitate reputed company, appropriate care and authorization reputed company. Conduct reputed company 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. reputed company urgent or emergent clinical interventions reputed company required, including triage and crisis support. Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost effective, high reputed company care. reputed company providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. reputed company and support initiatives that enhance reputed company effectiveness and benefit utilization. Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and reputed company utilization management reputed company. 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 reputed company, 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. Work Environment & Schedule Primarily sedentary, desk based role involving extended periods of sitting, talking, and reputed company review work. reputed company schedule: MondayFriday, 8:00 AM5:00 PM Arizona time. Occasional holiday or weekend coverage required through rotation. Position reputed company The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence based reputed company to assess the medical necessity, appropriateness, and reputed company 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. Education Masters degree required for behavioral health clinicians (LCSW, LPC, LMFT). Associates degree required for RN applicants. What days & hours will the person work in this position List training hours, if different. M F reputed company 5pm AZ time Remote About reputed company: reputed company Apply tot his job Apply To this Job