Behavioral Health Utilization Management Specialist

Behavioral Health Utilization Management Specialist

We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Key Responsibilities:

• Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
• Assess clinical documentation to determine medical necessity and appropriate level of care
• Ensure compliance with state, federal, and payer-specific regulations and guidelines
• Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
• Maintain accurate and timely documentation of all UM activities
• Participate in audits, quality improvement initiatives, and process enhancements
• Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care

Qualifications:

• Master's degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
• Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
• Prior experience in utilization management, managed care, or similar review functions required
• Strong attention to detail and critical thinking skills
• Excellent written and verbal communication abilities
• Ability to work independently while managing multiple priorities

What We Offer:

• Four-day work week promoting work-life balance
• Primarily remote work environment with flexible scheduling
• Collaborative and mission-driven team culture
• Opportunities for professional growth and development

Interested candidates should submit a resume and cover letter outlining their relevant experience and licensure status.

We are an equal opportunity employer committed to diversity, equity, and inclusion in the workplace.