Behavioral Health UM Specialist - AZ (Contract)

Randstad USA; Wallingford (CT); On-site; USD 51,000 - 55,000; Full time

Job summary

Randstad USA in Arizona seeks an Utilization Management Clinical Consultant (UMCC) to apply clinical expertise and evidence-based criteria to assess medical necessity and quality of behavioral health services for adults and children.

The role supports utilization of benefits across the care continuum through collaboration, clinical review, stakeholder communication, and timely authorization decisions.

Qualifications

• Must have an active Arizona LCSW, LPC, or LMFT.
• Experience performing behavioral health utilization management or clinical reviews.

Responsibilities

• Review clinical information and apply medical necessity criteria to render coverage determinations.
• Analyze medical records to ensure services align with evidence-based standards and quality benchmarks.
• Coordinate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions.
• Conduct concurrent reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care.
• Identify members who may benefit from care management programs and facilitate appropriate referrals.
• Provide urgent or emergent clinical interventions when required, including triage and crisis support.
• Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care.
• Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
• Develop and support initiatives that enhance quality effectiveness and benefit utilization.
• Prepare clinical reports and documentation to communicate findings, monitor KPIs, and track utilization management outcomes.

Skills

Behavioral Health Utilization Mgmt

Clinical Assessment & Critical Think

Communication & Coordination

Education

Bachelor's degree

Job description

Randstad USA in Arizona seeks an Utilization Management Clinical Consultant (UMCC) to apply clinical expertise and evidence-based criteria to assess medical necessity and quality of behavioral health services for adults and children.

The role supports utilization of benefits across the care continuum through collaboration, clinical review, stakeholder communication, and timely authorization decisions.