Healthcare Consultant III - Utilization Management Clinical Consultant – Behavioral Health

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This is a remote position but does require a BH licenses, those have to be active in Arizona Position Summary: The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to review behavioral health services for adult and child/adolescent members. This role evaluates medical necessity, supports appropriate utilization of benefits, and collaborates with providers to ensure quality, cost-effective care across the continuum of services.

Review clinical documentation to determine medical necessity and appropriateness of behavioral health services Apply clinical guidelines and tools such as InterQual, MCG, ASAM, or LOCUS Conduct initial, concurrent, and discharge reviews Coordinate with healthcare providers regarding authorizations and care planning Identify members who may benefit from care management or community resources Support continuity of care and safe discharge planning Provide urgent or emergent triage support when required Ensure accurate documentation and compliance with policies and regulatory standards Participate in quality improvement and utilization initiatives