Remote Utilization Management Clinical Consultant

Job Description

Job Description

A-Line Staffing is now hiring a Utilization Management Clinical Consultant. This will be full time.

If you are interested in Utilization Management Clinical Consultant Opportunity, please contact Michelle at 586-422-1171 or [email protected].

Utilization Management Clinical Consultant (LCSW, LPC, LMFT, or Active RN Compact License)

• Job Title: Utilization Management Clinical Consultant
• Location : Remote (Arizona-based, Arizona time zone)
• Pay Rate: $37.16 an hour
• Hours: Full-time, Monday–Friday (8:00 AM – 5:00 PM Arizona Time) -Occasional holiday/weekend rotation required
• Benefits : available to full-time employees after 90 days of employment

Position Summary:

A-Line Staffing is seeking a Utilization Management Clinical Consultant (UMCC) to apply clinical expertise in assessing the medical necessity, appropriateness, and quality of behavioral health services for both adult and child/adolescent members. This position will work collaboratively with healthcare providers and internal teams to ensure the appropriate utilization of benefits across the continuum of care. The UMCC will focus on facilitating timely care, reviewing clinical data, and supporting quality outcomes.

Key Responsibilities:

• Review Clinical Information : Apply medical necessity criteria (e.g., InterQual, MCG, ASAM, LOCUS) to determine coverage decisions, discharge planning, and service appropriateness.
• Concurrent Review : Monitor ongoing inpatient or outpatient treatment, ensuring that services align with clinical guidelines and quality benchmarks.
• Care Coordination : Work closely with healthcare providers, internal teams, and external stakeholders to coordinate appropriate care and facilitate timely authorization decisions.
• Clinical Interventions : Provide urgent or emergent clinical interventions when necessary, including triage and crisis support.
• Identify Care Management Needs : Identify members who may benefit from care management programs and facilitate appropriate referrals.
• Education and Training : Educate providers on utilization management processes, documentation requirements, and applicable guidelines.
• Resource Optimization : Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote high-quality, cost-effective care.
• Documentation and Reporting : Prepare clinical reports and monitor key performance indicators (KPIs) to track utilization outcomes and quality effectiveness.

Top Skills Required:

1. Behavioral Health Utilization Management : Expertise in applying medical necessity guidelines for reviewing authorizations, discharge planning, and ongoing treatment decisions.
2. Clinical Assessment & Critical Thinking : Strong ability to assess clinical needs, review medical records, and make decisions based on evidence-based practices.
3. Communication & Coordination : Excellent communication and organizational skills to collaborate with internal and external teams, and maintain accurate documentation.

Required Qualifications:

• Licensing :
• • LCSW (Licensed Clinical Social Worker), LPC (Licensed Professional Counselor), LMFT (Licensed Marriage and Family Therapist), OR Active RN Compact License specializing in behavioral health.
• Clinical Experience : Proven experience in behavioral health utilization management or clinical reviews, with a preference for experience with both adult and child/adolescent populations.