Patient Care Technicians - Behavioral Health Tech

Behavioral Health Utilization Manager

The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and substance use disorder services. This role serves as a key clinical decision-maker, exercising independent judgment and critical thinking in the evaluation of behavioral health service requests. The position is responsible for managing complex outpatient and non-24-hour diversionary cases. The role requires a proactive and analytical approach to service delivery, with a focus on clinical quality and compliance.

Responsibilities include using advanced clinical judgment to evaluate outpatient and non-24-hour behavioral health services. The manager determines the appropriateness of care based on individual member needs, clinical presentations, and professional standards. Collaboration with Medical Directors is required when clinical complexity necessitates further review. Identification of members who may benefit from enhanced care coordination or specialized interventions is essential. The manager must ensure accurate, timely documentation of clinical decisions per operational standards. Clear communication with internal and external stakeholders is vital to resolve questions or concerns. Participation in clinical rounds and interdisciplinary case discussions supports collaborative care planning and cross-functional learning. The role entails representing the organization with external partners and ensuring compliance with regulations. Monitoring clinical trends for potential indicators of Fraud, Waste, and Abuse is a key responsibility. Partnership with leadership will be necessary to evaluate existing processes and support initiatives aimed at improving quality. Crisis intervention support using clinical judgment to de-escalate situations is a required function of the role. The manager must uphold all organizational policies, professional standards, and compliance requirements. Opportunities to contribute to special projects and initiatives will arise as assigned by senior leadership. Providing Network Management in collaboration with other organizations may require some travel within designated areas.

Must-Have: Master's degree in Social Work, Psychology, Counseling, or a related Behavioral Health field. Expertise in utilization management and medical necessity determinations. Experience with Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services is preferred. Proficiency in Microsoft Office applications, particularly Outlook, Word, and Excel.