Behavioral Health Utilization Management Clinician, Senior

The Behavioral Health Utilization Management Clinician, Senior conducts clinical reviews of mental health and substance use authorization requests to determine medical necessity, coding accuracy, and compliance with established guidelines. This role involves performing prospective and concurrent utilization reviews, collaborating with multidisciplinary teams, and supporting members through the continuum of care. The position requires applying clinical judgment and standardized criteria to render coverage determinations and facilitate effective discharge planning.