Licensed Behavioral Health UM Specialist – PHP/IOP

GeBBS Consulting; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

GeBBS Consulting is seeking a Behavioral Health UM Specialist to support utilization management reviews for mental health services, including Partial Hospitalization Programs and Intensive Outpatient Programs. The role reviews patient information against guidelines, handles about 25 cases per day, and communicates with providers for needed information while applying UM criteria.

Training will be provided for 1–2 weeks.

Qualifications

• Must be licensed in DC, MD, or VA as LCSW/LPC/LCPC.
• 5+ years of clinical experience.
• Some prior-authorization or utilization management experience.
• Substance health or mental health background.
• Experience with MCG, Apollo, or ASAM/FEP guidelines.

Responsibilities

• Review mental health cases for PHP/IOP utilization.
• Assess clinical information against guidelines.
• Manage ~25 cases per day and communicate with providers.
• Use UM systems and criteria like MCG, Apollo, and ASAM/FEP.
• Ensure services are appropriately authorized per policies.

Skills

Utilization management

Mental health

Provider communication

Clinical documentation

Education

Licensed in DC, MD, or VA (LCSW/LPC/LCPC)

Tools

GuidingCare

MCG

Apollo

ASAM/FEP guidelines

Job description

GeBBS Consulting is seeking a Behavioral Health UM Specialist to support utilization management reviews for mental health services, including Partial Hospitalization Programs and Intensive Outpatient Programs. The role reviews patient information against guidelines, handles about 25 cases per day, and communicates with providers for needed information while applying UM criteria.

Training will be provided for 1–2 weeks.