Utilization Management Behavioral Health

Job Description This hybrid position combines Utilization Review and Care Management responsibilities to ensure members receive high‑quality, cost‑effective care. The role involves detailed assessments, evidence‑based guidelines, and coordination among healthcare professionals to achieve optimal outcomes. Sign‑On Bonus External LCSW applicants only: $2,500 sign‑on bonus for those with 1+ year of experience. Job Specifics Pay Range (LCSW): $38.77 – $59.82 (exempt) Benefits eligible: Yes FTE: Full time Shift: Hybrid. Monday‑Friday, 8:00 am – 4:30 pm (schedule finalized upon hire). Occasional weekends and holidays. Required LCSW licensure Essential Functions Utilization Review and Care Management of members with specific treatment plans, conditions, or diagnoses including medical and behavioral health conditions. Provide ongoing training and support to families and caregivers. Collect, analyze, and interpret data to evaluate the effectiveness of interventions. Stay current with the latest research and best practices in the assigned population. Inform Select Health Medical and Behavioral Health policy and procedure. Peer‑to‑peer and peer review to ensure adherence to ethical standards and regulatory requirements. Occasional travel to provider locations within the Select Health region. Review medical records to determine the medical necessity of services. Evaluate the appropriateness of procedures, diagnostic assessments, functional behavior assessments, and treatment plans. Make timely and informed determinations about the medical necessity and appropriateness of services. Adhere to regulatory requirements, payer guidelines, and ethical standards. Facilitate communication, organize collaborative meetings, and resolve conflicts with healthcare providers to ensure coordinated member care. Communicate with members, families, and insurance representatives. Conduct comprehensive assessments of members' needs. Develop and implement individualized care plans. Educate and empower members and families. Advocate for members' rights and access to care. Monitor and evaluate the effectiveness of care plans. Minimum Qualifications Master’s degree in Social Work. Current licensure or Certification in Utah: LCSW. Candidate may be required to obtain licensure in other states within the Select Health region within 90 days of employment. Demonstrated clinical expertise and experience in related behavioral health field. Minimum 1 year of experience in Utilization Management or a closely related field (e.g., Utilization Review, Case Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator). Intermediate computer and hardware setup skills, ability to customize computer settings and use multiple monitors, and capability to troubleshoot internet and applications independently. Preferred Qualifications Three years of experience and expertise working in a clinical behavioral setting or utilization management. Ability to work independently and be flexible in a rapidly changing environment. Excellent written and verbal communication skills. Experience working remotely or using advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) and Outlook. Knowledge of healthcare insurance and utilization review processes. Knowledge of regulatory requirements (NCQA, CMS, and state‑specific regulations) related to the field. Ability to travel as needed. Physical Requirements Ongoing need for employees to see and read information, documents, monitors, and identify equipment and supplies, and assess customer needs. Frequent interactions with colleagues and providers require verbal communication and rapid comprehension of spoken information. Manual dexterity to manipulate complex equipment with precision; frequent computer use for typing. May be expected to sit or stand in a stationary position for an extended period. Location Murray, Utah. Hours & Compensation 40 hours per week. Hourly rate $38.77 – $59.82, dependent on experience. Benefits Generous benefits package covering health, wellness, and security programs. Equal Opportunity Statement Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Recruitment Process We use the HiredScore AI platform to improve the job application experience while maintaining final hiring decisions and privacy. Application Status All positions subject to close without notice. #J-18808-Ljbffr