Fully Remote Utilization Consultant - MUST LIVE IN AZ {176341}

Job Description

Job Description

A-Line Staffing is now hiring a Utilization Management Clinical Consultant (LCSW, LPC, LMFT, or Registered Nurse) – Behavioral Health

• Location: Remote – Arizona
• Schedule: Monday–Friday, 8:00 AM–5:00 PM Arizona Time
• Weekend/Holiday: Occasional coverage through rotation
• Pay Rate: $37.16 an hour
• Benefits – active after 90 days

Key Responsibilities

• Review clinical information and medical records to determine medical necessity and appropriateness of behavioral health services.
• Apply clinical guidelines, policies, and medical necessity criteria to coverage determinations.
• Conduct initial, concurrent, and discharge planning reviews.
• Evaluate clinical documentation and identify opportunities to improve quality, continuity, and appropriate utilization of services.
• Communicate with providers, clinical teams, members, and other stakeholders regarding authorization and care coordination.
• Identify members who may benefit from care management programs and facilitate appropriate referrals.
• Provide urgent or emergent clinical support, including triage and crisis intervention when required.
• Support safe and appropriate transitions of care and discharge planning.
• Identify opportunities to reduce unnecessary services while maintaining quality and member-centered care.
• Educate providers, under appropriate supervision, regarding utilization management processes, documentation requirements, and applicable guidelines.
• Maintain accurate clinical documentation and prepare reports related to utilization management outcomes and performance indicators.
• Support initiatives focused on quality, effectiveness, and appropriate benefit utilization.

Required Qualifications

• Master’s degree is required for behavioral health clinicians.
• Associate’s degree required for RN applicants.
• Active Arizona LCSW, LPC, or LMFT license required for behavioral health clinician candidates OR active compact RN license with behavioral health experience.
• Behavioral health utilization management or clinical review experience
• Experience with medical necessity criteria such as InterQual, MCG, ASAM, and/or LOCUS preferred

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