This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Behavioral Health Professional in the United States.
This role focuses on supporting appropriate, high-quality behavioral health care through clinical review, utilization management, and care coordination activities. You will apply your behavioral health expertise to evaluate treatment requests, interpret clinical criteria, and ensure members receive the most effective and appropriate level of care. Working in a remote, fast-paced healthcare environment, you will collaborate with providers, members, and internal teams to support informed benefit and care decisions. The position requires strong clinical judgment, critical thinking, and the ability to work independently while following established guidelines. You will also contribute to communication and coordination efforts that help improve health outcomes and streamline service delivery. This is a meaningful role for a licensed behavioral health professional seeking to make a direct impact on patient care quality and access.
Accountabilities:
- Conduct utilization management reviews by applying clinical guidelines, policies, and behavioral health expertise to determine appropriate levels of care.
- Coordinate with providers, members, and internal teams to support care decisions, treatment planning, and benefit determinations.
- Document and communicate clinical decisions clearly, ensuring accuracy, compliance, and consistency with organizational standards.
- Interpret complex cases and make independent decisions within established frameworks while escalating when necessary.
- Collaborate with multidisciplinary teams to support care coordination, case management, and member engagement.
- Participate in quality improvement initiatives and contribute to process efficiency and best practice development.
Requirements:
- Active, unrestricted license as an RN, LCSW, LPC, LMFT, LCP, or Clinical Psychologist, valid in Virginia or eligible under compact licensure.
- Minimum 1 year of post-degree clinical experience in a behavioral health or direct patient care setting.
- At least 1 year of experience in managed care or utilization review processes.
- Strong knowledge of behavioral health conditions, including inpatient psychiatry, substance use, or related treatment settings.
- Proficiency with Microsoft Office tools and ability to navigate multiple digital systems in a remote environment.
- Strong communication, problem-solving, and interpersonal skills with the ability to work independently and collaboratively.
- Experience in behavioral health coaching, health promotion, or community resources is a plus.
Benefits:
- Annual salary range: $65,000 – $88,600, plus potential bonus incentive opportunities based on performance.
- Comprehensive medical, dental, and vision insurance coverage.
- 401(k) retirement savings plan with employer support.
- Paid time off, including holidays, parental leave, caregiver leave, and volunteer time off.
- Short-term and long-term disability, life insurance, and wellness-focused programs.
- Fully remote work model with structured support and occasional travel opportunities.
- Access to professional development and training in behavioral health and utilization management.