Duration: months contract
Note: Must be residing in AZ



Position Summary

The Utilization Management Clinical Consultant (UMCC) is responsible for evaluating the medical necessity, appropriateness, and quality of behavioral health services for adult and pediatric members. This role applies clinical expertise and evidence-based guidelines to support optimal utilization of healthcare benefits while ensuring high-quality, member-centered care. The UMCC collaborates with providers, care teams, and stakeholders to facilitate timely care decisions and continuity of care.



Key Responsibilities

Review clinical documentation and apply medical necessity criteria, guidelines, and policies to make coverage and care decisions

Analyze medical records to ensure alignment with evidence-based standards and quality benchmarks

Conduct concurrent reviews for inpatient and outpatient services to support ongoing care needs