Behavioral Health Utilization Management Clinician, Senior

TieTalent; Long Beach (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

A leading company is seeking a Senior Behavioral Health Utilization Management Clinician to join their dedicated team. This role involves conducting clinical reviews and ensuring compliance with evidence-based guidelines across multiple business lines. The ideal candidate will possess strong analytical capabilities, excellent communication skills, and a valid CA license. Join us in supporting member care through an integrated team approach.

Qualifications

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD, or RN with Behavioral Health experience) required.
• Requires at least five (5) years of prior experience in a healthcare related field.
• Three (3) years in Behavioral Health Utilization Management for a health insurance plan is necessary.

Responsibilities

• Conduct clinical reviews of mental health and substance use authorization requests.
• Perform prospective & concurrent utilization reviews following BSC guidelines.
• Gather clinical information to make coverage determinations.

Skills

Analytical skills

Communication skills

Organizational skills

Interpersonal skills

Education

Advanced degree in a relevant field

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Job description

Join to apply for the Behavioral Health Utilization Management Clinician, Senior role at TieTalent

1 day ago Be among the first 25 applicants

Join to apply for the Behavioral Health Utilization Management Clinician, Senior role at TieTalent

Your Role

The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.

About

Job Description

Your Role

The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.

Responsibilities

Your Work

In This Role, You Will

• Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed
• Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination
• Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
• Work with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed Manager
• Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
• Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards
  
  

Qualifications

Your Knowledge and Experience

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required
• Advanced degree commensurate with field is preferred
• Requires at least five (5) years of prior experience in healthcare related field
• Three (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment required
• Strong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines
• Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
• Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases
• Excellent analytical, communication skills, written skills, time management, and organizational skills
• Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
• Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
  
  

Nice-to-have skills

• Microsoft Excel
• Microsoft Outlook
• Microsoft Word
• Microsoft PowerPoint
• Long Beach, California
  
  

Work experience

• Healthcare
  
  

Languages

• English

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Technology, Information and Internet

Referrals increase your chances of interviewing at TieTalent by 2x

Sign in to set job alerts for “Behavioral Health Specialist” roles.

Behavior Technician - Naturalistic Play Based ABA Therapy

Los Angeles County, CA $33.09-$40.19 1 month ago

Behavioral Health Clinical Quality Specialist (45277)

Behavioral Health Operations Specialist II

Behavior Technician - Play Based ABA Therapy

Behavioral Health Administrative Assistant

Los Angeles Metropolitan Area $23.88-$28.66 2 weeks ago

Child and Family Specialist, Mental Health

Los Angeles Metropolitan Area 4 weeks ago

Behavioral Health Clinical Quality Specialist (45277)

Los Angeles Metropolitan Area 1 month ago

Tustin, CA $60,000.00-$65,000.00 3 weeks ago

Orange, CA $49,754.00-$69,655.00 2 weeks ago

Behavior Technician Childcare Experience Needed

2025-26 Mental Health Support Provider (MSA SA)

Behavior Technician Childcare Experience Needed

Behavior Therapist – Registered Behavior Technician

Culver City, CA $22.00-$26.00 7 months ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.