Behavioral Health UM Clinician

Medix™; New York (NY); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Contract-to-hire potential

Career growth opportunities

Job summary

A healthcare organization is seeking a Behavioral Health Utilization Management (BH UM) Clinician in New York City. This role emphasizes the management of healthcare costs while ensuring high-quality care through various reviews. Candidates should have a Master’s Degree and at least 3 years of relevant experience. The position includes conducting reviews, collaborating with medical professionals, and participating in quality improvement initiatives. This opportunity offers long-term career growth within a mission-driven program.

Qualifications

• Minimum 3+ years of experience in Behavioral Health, including SMI and SUD.
• Experience in utilization review, quality assurance, or discharge planning.
• Strong communication and collaboration skills with providers.

Responsibilities

• Conduct telephonic utilization reviews for behavioral health services.
• Collaborate with Medical Director on cases not meeting criteria.
• Provide coverage for retrospective reviews and appeals as needed.

Skills

Behavioral health experience

Utilization review

Strong communication skills

Collaboration with interdisciplinary teams

Education

Master’s Degree in a related field

Tools

Clinical review tools (e.g., InterQual, LOCADTR)

Utilization management systems/tools (e.g., Psyckes, ePACES)

Job description

Schedule: Monday–Friday, 9:00 AM – 5:00 PM

Overview

We are seeking a Behavioral Health Utilization Management (BH UM) Clinician to support utilization and quality management initiatives. This role focuses on managing healthcare costs while ensuring high-quality, appropriate care through prospective, concurrent, and retrospective reviews.

Key Responsibilities

• Conduct telephonic utilization reviews for inpatient and outpatient behavioral health services using established clinical criteria
• Perform prospective, concurrent, and retrospective reviews to determine medical necessity and appropriate level of care
• Collect, evaluate, and document clinical information in the electronic health record system
• Communicate with physicians and provider teams to obtain necessary clinical details
• Collaborate with the Medical Director on cases not meeting medical necessity or level of care criteria
• Recommend and coordinate alternative, cost-effective care options and treatment plans
• Educate providers on treatment adherence, medication compliance, and long-acting injectables
• Promote early intervention programs and alternatives to inpatient care when appropriate
• Participate in interdisciplinary care team meetings for high-risk or high-utilizing members
• Support discharge planning and continuity of care for inpatient populations
• Identify high-risk or complex cases and refer to case management as needed
• Evaluate social determinants of health, including housing needs, and coordinate internal support services
• Identify and escalate quality of care concerns in a timely manner
• Contribute to quality improvement initiatives, audits, training, and special projects
• Provide coverage for retrospective reviews and behavioral health appeals as needed

Required Qualifications

• Master’s Degree in a related field
• Minimum 3+ years of Behavioral Health experience, including Serious Mental Illness (SMI) and Substance Use Disorder (SUD)
• Experience in utilization review, quality assurance, or discharge planning within managed care or clinical settings
• Familiarity with clinical review tools and criteria sets (e.g., InterQual, LOCADTR)
• Experience working in inpatient and/or outpatient psychiatric settings
• Strong communication and collaboration skills with providers and interdisciplinary teams

Preferred Qualifications

• Experience within an Integrated Collaborative Care Model
• Knowledge of chronic condition management (e.g., diabetes, HIV, heart disease)
• Familiarity with systems/tools such as Psyckes, ePACES, MAPP, HCS (UAS)
• Background in quality management and HEDIS/QARR performance initiatives
• Experience working with hospitals or high-volume provider groups

What Makes This Opportunity Stand Out

• Opportunity to work within a mission-driven behavioral health program
• Exposure to complex, high-impact cases and interdisciplinary collaboration
• Contract-to-hire potential with long-term career growth
• Work with innovative care models focused on quality, outcomes, and cost efficiency