BH UM Clinician - Fully remote

MetroPlusHealth; New York (NY); Remote; USD 87,000; Full time

Job summary

A leading healthcare provider seeks a BH UM Clinician to manage utilization and quality management activities. This fully remote role requires a Master's degree and experience in behavioral health. Join a team committed to empowering communities through care.

Qualifications

• At least 3 years of behavioral health experience in managed care.
• Knowledge of pharmacy and integrated care models.

Responsibilities

• Perform telephonic reviews for inpatient and outpatient services.
• Collect and document clinical information within CareConnect.
• Educate providers on alternative care options.

Skills

Communication

Customer Service

Teamwork

Technical Skills

Interpersonal Assessment

Education

Master’s Degree

Tools

InterQual

LOCADTR

Job description

Join to apply for the BH UM Clinician - Fully remote role at MetroPlusHealth.

This range is provided by MetroPlusHealth. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$86,500.00/yr - $86,500.00/yr

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 providers and clinics. For over 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest lives.

Position Overview

The Behavioral Health Utilization Management (BH UM) Clinician conducts utilization and quality management activities according to NY State and MetroPlusHealth policies. Responsibilities include managing medical costs through timely review activities.

Job Responsibilities

• Perform telephonic reviews for inpatient and outpatient services using InterQual, LOCADTR, and OMH Criteria Sets.
• Contribute to UM program goals in cost containment and quality healthcare delivery.
• Collect and document clinical information within CareConnect.
• Promote alternative care programs and research options, including costs and appropriateness.
• Communicate with providers to gather clinical information and determine medical necessity.
• Coordinate with Medical Director on inpatient and outpatient requests.
• Educate providers on alternative care options and medication compliance.
• Attend interdisciplinary care team meetings and evaluate housing needs.
• Assist with discharge planning and high-risk case management.
• Report quality concerns and participate in audits and quality improvement projects.
• Support retrospective reviews and appeals as needed.

Minimum Qualifications

• Master’s Degree required.
• At least 3 years of behavioral health experience in managed care, including utilization review and discharge planning.
• Experience with integrated care models and chronic condition management.
• Knowledge of pharmacy, LOCADTR, InterQual, and related tools.
• Medical background and bilingual skills preferred.

Licensure and Certifications

• LCSW, LMSW, or LMHC with a current NY State license.

Professional Competencies

• Integrity, teamwork, customer service, technical skills, organizational and communication skills, interpersonal assessment skills.

Additional Details

• Seniority level: Mid-Senior level.
• Employment type: Full-time.
• Job function: Healthcare Provider.
• Industries: Hospitals and Healthcare.