Behavioral Health UM Clinician (LSW, LISW, RN)

Behavioral Health Utilization Management Clinician provides utilization management for behavioral health and substance use disorder levels of care, processes clinical documentation, and reviews services against plan language and criteria. The role includes discharge planning collaboration, coordinating with providers and facilities, and communicating outcomes to patients, providers, and internal teams. Responsibilities encompass initial, concurrent, and retrospective clinical reviews, adherence to clinical criteria and Quantum Health workflows, and negotiation for services when benefits are unclear or out-of-network. Partners with MDs and external reviewers, supports residential and outpatient services (Residential, PHP, IOP), and contributes to integrated health management while maintaining high-quality medical reviews and outcomes.