Remote Care Consultant – Utilization Mgmt & Behavioral Health {166940}

A-Line Staffing is now hiring a “166940 Healthcare Consultant III – Utilization Management Clinical Consultant – Behavioral Health in Arizona (Remote)”, please contact Staffing Manager, Tiona Scroggins @ tscroggins@alinestaffing.com Position Title: 166940 Healthcare Consultant III – Utilization Management Clinical Consultant – Behavioral Health Location: Remote (Must hold active Arizona license; work hours based on Arizona time zone) Start Date: Flexible Targeted Start Date: April 13, 2026 Assignment Type: Temporary to Permanent (Opportunity to extend or convert to permanent based on business needs) Pay Rate: $37.16 per hour Schedule: Monday – Friday, 8:00 AM – 5:00 PM Arizona Time Work Environment: Fully remote, desk-based role (onsite as needed) Coverage: Occasional holiday or weekend rotation required Position Summary The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to evaluate 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 comprehensive clinical review, collaboration, and stakeholder communication. This is a non-patient-facing, remote position requiring strong independent decision-making skills and the ability to work in a confidential home office environment.

Review clinical documentation and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render authorization and discharge planning decisions. Conduct initial, concurrent, and discharge reviews for behavioral health services (inpatient and outpatient). Analyze medical records to ensure alignment with evidence-based standards and quality benchmarks. Coordinate with providers, internal teams, and external stakeholders to support timely and appropriate care decisions. Identify members appropriate for care management programs and facilitate referrals. Provide urgent or emergent clinical interventions as needed, including triage and crisis support. Promote cost-effective, high-quality care through optimization of resource utilization. Educate providers (as appropriate) on utilization management processes and documentation standards. Develop and support quality improvement and benefit utilization initiatives. Prepare clinical documentation, reports, and KPI tracking related to utilization outcomes.