Job description
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.
Responsibilities
- 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
Requirements
- Active Arizona license:
LCSW (Licensed Clinical Social Worker)
LPC (Licensed Professional Counselor)
LMFT (Licensed Marriage and Family Therapist)
OR
RN with active compact license and behavioral health focus
Master’s degree required for behavioral health clinicians
Associate’s degree required for RN applicants
Experience in behavioral health utilization management or clinical review
Strong knowledge of medical necessity criteria (InterQual, MCG, ASAM, LOCUS preferred)
Excellent communication and documentation skills
Ability to work independently in a remote environment
About USTech GCC Private Limited
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
