[Hiring] Behavioral Health Utilization Care Manager @Banner Health

Role Description

As a Behavioral Health Utilization Care Manager, you will be assigned to various hospitals where you will:

• Authorize initial admitting and conduct concurrent reviews for medical necessity.
• Work with facilities and out-patient providers, collaborating with other reviewers if there is a change to patients' continuum of care.
• Utilize your clinical experience, excellent collaboration skills, strong time management, and communication abilities to meet requirements for compliance and member care.

Your work schedule will be Monday-Friday primarily 8:00 a.m.- 5:00 p.m. Arizona Time Zone. This position is entirely remote and requires Arizona residency for compliance.

This position is the point person for all utilization activities for assigned members. Responsibilities include:

• Reviewing and authorizing behavioral health and substance abuse services in inpatient, residential, and outpatient settings using approved medical necessity criteria.
• Monitoring care to ensure treatment is appropriate and effective.
• Assessing the member’s plan of care and developing, implementing, monitoring, and documenting the utilization of resources and progress of the member through their care.
• Facilitating options and services to meet the member’s health care needs.
• Providing telephonic or electronic document review.
• Engaging internal and external resources to ensure members receive appropriate care plan and discharge planning services.
• Monitoring for quality of care concerns and staffing regularly with medical directors.
• Providing education and recommending alternative care plans for treatment not meeting medical necessity criteria.
• Being accountable for the quality of clinical services delivered by yourself and others.
• Identifying and resolving barriers that may hinder effective care delivery to members.
• Conducting prior authorization, concurrent, retrospective, and appeal reviews.

Qualifications

• Master’s degree in social work, counseling, or related field with independent or associate licensure.
• Licensure in at least one of the following categories as required by state law: Social work, professional counseling, or marriage and family.
• Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.
• Three years of clinical experience (i.e., counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
• Working knowledge of care management, case management, hospital, and community resources.
• Demonstrated critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
• Ability to work effectively independently and in an interdisciplinary team format.

Requirements

• Previous experience with behavioral health utilization management (preferred).
• Additional related education and/or experience (preferred).

Benefits

• Comprehensive benefits package.
• Opportunities for personal and professional growth.
• Inclusive and empowering work environments.
• Resources that promote a healthy work-life balance.

Company Description

Banner Health was recognized on Becker's Healthcare 2025 list of 150+ top places to work in healthcare. This recognition highlights our commitment to supporting team members through comprehensive benefits, opportunities for both personal and professional growth, inclusive and empowering work environments, and resources that promote a healthy work-life balance.

Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans, known nationally as an innovative leader. BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs.