Behavioral Health Utilization Management Specialist

Barry County Community Mental Health Aut•Hastings, MI

5d•$0 - $58,473•Remote

About The Position

We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Requirements

Master’s degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
Prior experience in utilization management, managed care, or similar review functions required
Strong attention to detail and critical thinking skills
Excellent written and verbal communication abilities
Ability to work independently while managing multiple priorities

Nice To Haves

Experience with behavioral health payer guidelines and authorization processes
Familiarity with electronic health records and UM software systems

Responsibilities

Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
Assess clinical documentation to determine medical necessity and appropriate level of care
Ensure compliance with state, federal, and payer-specific regulations and guidelines
Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
Maintain accurate and timely documentation of all UM activities
Participate in audits, quality improvement initiatives, and process enhancements
Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care