BH UM Clinician - Fully remote

NYC Health + Hospitals; New York (NY); Remote; USD 87,000; Full time

Job summary

Join a leading healthcare organization as a BH UM Clinician, where you'll conduct utilization management and quality assurance activities. This fully remote role involves reviewing inpatient and outpatient services, collaborating with healthcare providers, and ensuring high-quality care for patients. If you are passionate about making a difference in the healthcare system and have the necessary qualifications, we invite you to apply.

Qualifications

• At least 3 years of Behavioral Health experience in managed care.
• Experience with integrated care models and chronic condition management.

Responsibilities

• Conduct telephonic reviews for inpatient and outpatient services.
• Communicate with providers to gather clinical information.
• Evaluate housing needs and collaborate with internal support teams.

Skills

Problem-Solving

Integrity

Teamwork

Excellent Customer Service

Communication

Education

Master’s Degree

Tools

Microsoft Office

Care Connect

Teams

InterQual

Psyckes

E-Paces

LOCADTR

Job description

Join to apply for the BH UM Clinician - Fully remote role at NYC Health + Hospitals

NYC Health + Hospitals provided pay range

This range is provided by NYC Health + Hospitals. 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

Position Overview

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

The Behavioral Health Utilization Management (BH UM) Clinician is responsible for conducting utilization and quality management activities in accordance with New York State and MetroPlusHealth policies. Responsibilities include managing medical costs through prospective, concurrent, and retrospective reviews.

Job Responsibilities

1. Perform telephonic reviews for inpatient and outpatient services using InterQual, Secondary Dimensions & LOCADTR, and OMH Criteria Sets.
2. Contribute to UM program goals in containing healthcare costs and maintaining high-quality medical delivery.
3. Collect and document clinical information within CareConnect.
4. Promote alternative care programs and research options including costs and appropriateness of patient placement in collaboration with members.
5. Communicate with providers to gather clinical information and determine medical necessity.
6. Discuss inpatient and outpatient requests with Medical Director regarding medical necessity and care levels.
7. Educate providers on alternative care options and medication compliance, including Long Acting Injectables.
8. Attend bi-weekly interdisciplinary care team meetings for high-risk members.
9. Evaluate housing needs and collaborate with internal support teams.
10. Ensure continuity of inpatient care through discharge planning.
11. Identify high-risk cases for case management referral.
12. Report quality concerns promptly.
13. Participate in team activities, education, and special projects.
14. Support retrospective reviews and appeals as needed.

Minimum Qualifications

1. Master’s Degree required.
2. At least 3 years of Behavioral Health experience in managed care, including utilization review, discharge planning, and quality assurance.
3. Experience with integrated care models and chronic condition management.
4. Proficiency with tools such as Pharmacy, Psyckes, E-Paces, LOCADTR, InterQual, and others.
5. Bilingual skills and medical background preferred.

Licensure and Certification

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

Professional Competencies

• Integrity, trust, teamwork, problem-solving.
• Excellent customer service, organizational, and communication skills.
• Technical proficiency with Microsoft Office, Care Connect, and Teams.
• Strong interpersonal skills and ability to handle challenging providers.