Utilization Review Clinical Specialist
About The Position
BHSN, one of the fastest-growing organizations providing whole-person care in the region, is in search of passionate individuals to join our rapidly expanding team! The Utilization Review Clinical Specialist (URCS) conducts clinical utilization review and supports utilization management across BHSN programs, with an emphasis on the CCBHC model. The URCS evaluates medical necessity, level of care, service intensity, frequency, and duration to ensure services are clinically appropriate and aligned with individual needs. The URCS provides clinical consultation to supervisors and treatment teams and promotes a collaborative, clinically driven approach that balances individual choice, access, quality, outcomes, and responsible resource use. The position supports quality improvement, continuity of care, effective service delivery, and compliance with applicable OMH, OASAS, CCBHC, Medicaid, and regulatory requirements.
Requirements
- Master's degree and current NY State license in Social Work, Mental Health Counseling, Psychology, Marriage and Family Therapy, or other closely related behavioral health disciplines.
- Experience providing behavioral health services in an outpatient, community mental health, CCBHC, hospital, or other integrated behavioral health setting.
- Demonstrated knowledge of behavioral health assessment, treatment planning, medical necessity, level-of-care determination, and clinical documentation.
- Strong understanding of clinical risk assessment and behavioral health service delivery.
- Ability to independently review complex clinical information and formulate clinically sound recommendations.
Responsibilities
- Conducts prospective, concurrent, retrospective, and continued-stay reviews to assess medical necessity, clinical appropriateness, level of care, service intensity, frequency, and duration.
- Completes required continued-need reviews within established timeframes and identifies underutilization, overutilization, and changes in clinical need.
- Reviews and recommends level-of-care changes based on clinical presentation, risk, functioning, engagement, and service utilization.
- Provides clinical consultation and recommendations to supervisors, program leadership, and treatment teams.
- Identifies barriers to engagement and collaborates with teams on outreach, re-engagement, care planning, and access to services.
- Reviews utilization across disciplines and levels of care to support care coordination, service bundling, appropriate service intensity, and continuity of care.
Benefits
- Generous benefits, including personalized health coverage, paid time off, and holiday pay
- Working within our community, making a real impact, working alongside passionate colleagues
- Accessible leadership team, coaching for your growth, and ample training opportunities
- As a rapidly growing organization, there are endless opportunities to grow within the organization
- Community discounts, loan forgiveness & more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
