Utilization Management Clinical Specialist

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following our Accessibility Accomodation for Applicants page. Locations Showing 1 location Hospital - Towson Towson, MD 21204, USA On-site Salary Range : $67,999.78 USD to $108,576.83 USD Nursing Full-Time Requisition #: UTILI012940 Description What to expect: Provides timely, comprehensive utilization reviews for behavioral health services for Sheppard Pratt patients. Conducts medical reviews for inpatient and partial hospitalization programs, maintains accurate documentation within hospital data systems, and communicates effectively with internal stakeholders and external agencies. Coordinates with Medicare, Medicaid, and Commercial Health Plans to ensure compliance with CMS (Centers for Medicare & Medicaid Services), Maryland Medicaid, and payer-specific requirements. Leads the appeals process through data-driven analysis, optimized workflows, and strengthened clinical documentation to support medical necessity decisions and successful appeal outcomes. What you’ll get from Us: At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer: A commitment toprofessional development,includinga comprehensive tuition reimbursement program tosupport ongoing education and licensure and/or certification preparation Comprehensive medical, dental and vision benefitsfor benefit eligible positions 403b retirement match Generous paid-time-offfor benefit eligible positions Complimentary Employee Assistance Program (EAP) Pay for this position is determined ona number offactors, including but not limited to,yearsand levelof related experience. What we need from You: Associate or Bachelor’sdegree in nursing,Bachelor’s orMaster’sdegree inClinical Counseling,Healthcare Administration, or related clinical field. Active RN license, Licensed Clinical Professional Counselor(LCPC), or Licensed Certified Social Worker-Clinical (LCSW-C). Minimum of 3-5 years of experience inutilizationmanagement,orbehavioral health. Strong knowledge of payer requirements, clinicalcriteriaand behavioral health diagnosis.

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