Behavioral Health Clinician - Utilization Management

Behavioral Health Utilization Management Clinician (Work‑From‑Home | Monday–Friday)

Schedule: Monday–Friday, Standard Business Hours (EST)
Location: Work From Home
No weekends. No holidays.

About the Role

We are seeking a highly skilled, detail‑oriented Behavioral Health Utilization Management Clinician to join our growing team. In this fully remote role, you will leverage your clinical expertise to support our utilization/benefit management program, ensuring members receive high‑quality, evidence‑based, and cost‑effective behavioral healthcare.

This position is ideal for a clinician who excels in critical thinking, thrives in a structured environment, and is passionate about facilitating positive outcomes for members across diverse levels of care.

What You’ll Do

• Apply clinical judgment to review and evaluate treatment plans across multiple levels of care, ensuring alignment with evidence‑based standards and clinical guidelines.
• Coordinate, monitor, and assess healthcare service options to ensure members receive appropriate, cost‑effective care.
• Gather and evaluate clinical information to inform coverage recommendations, including discharge planning and transitions of care.
• Collaborate with providers and interdisciplinary teams to support optimal treatment outcomes.
• Identify high‑risk members and connect them with internal programs or additional resources to support their care needs.
• Identify opportunities to improve care quality, service effectiveness, and benefit optimization.
• Act as a clinical resource for internal teams and external partners regarding utilization management processes.
• Perform responsibilities primarily through computer‑based work and extended periods of phone communication.
• Render clinical decisions within mandated turnaround times, requiring dependable, consistent availability during standard business hours.

Required Qualifications

• Active, current, and unrestricted Master's‑level Behavioral Health license in your state of residence
  (e.g., LMSW, LCSW, LISW, LPC, or comparable)
  OR
  Registered Nurse licensure with psychiatric specialty, certification, or experience.
• Ability to work Monday–Friday, Standard EST Business Hours (no evenings, weekends, or holidays).
• 1+ years of Utilization Review/Utilization Management experience required.
• 3+ years of Behavioral Health clinical experience in a hospital setting.
• Recent experience in an inpatient hospital behavioral health setting, or continuous, recent behavioral‑health‑focused work since that experience.
• Ability to meet mandated decision turnaround times with limited schedule flexibility.

Preferred Qualifications

• Experience working with geriatric or chronically mentally ill populations.
• Experience supporting high‑risk or complex‑needs member populations.
• Strong computer proficiency, including navigating multiple systems simultaneously and accurate typing skills.

Education

• Master’s degree in a Behavioral Health discipline
  OR
• Associate Degree in Nursing (ADN) with Behavioral Health experience
  BSN preferred

Why Join Us?

• 100% Remote—no commute, no weekend shifts, no holiday work
• Meaningful, member‑focused work that impacts real lives
• Collaborative, supportive clinical team
• Opportunities for professional growth in a structured and respected UM environment