[Hiring] Behavioral Health Utilization Management Clinical Coordinator @UnitedHealth Group

Role Description

The Clinical Coordinator is responsible for processing all Behavioral Health and Substance Use Disorder authorizations within designated turnaround times for various lines of business. This role involves:

• Applying approved medical necessity criteria.
• Escalating cases to secondary medical director review when necessary.
• Collaborating with leadership and medical directors on complex cases.
• Proactively managing and identifying potential barriers for members.
• Referring members to the RMHP Care Coordination Department for specific needs.
• Notifying providers and requestors of authorization determinations.
• Offering peer-to-peer consultations when cases do not meet criteria.
• Drafting denial letters and validating eligibility.
• Inputting authorization requests into electronic health records.
• Providing assistance to callers.
• Completing required trainings and participating in annual Inter-Rater Reliability testing.
• Engaging members in the RMHP Contingency Management Program.
• Collaborating with facility staff and providing consultations.
• Maintaining confidentiality and supporting evidence-based practices.
• Identifying the need for higher-level reviews and formulating case overviews.
• Administering benefits and handling escalated calls.
• Applying clinical knowledge to determine medical appropriateness.

Qualifications

• Current, unrestricted independent licensure as a LAC, LPC, LMFT, or LSCW in Colorado.
• 4+ years directly serving individuals with behavioral health conditions (mental health/substance use disorders).
• 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH.
• 1+ years of experience with MS Office, including Word, Excel, and Outlook.
• Substance use treatment experience and/or behavioral health treatment experience.
• Ability to work Monday - Friday, 9:30 AM - 6:00 PM Mountain Standard Time.

Requirements

• Utilization Management experience (preferred).
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (subject to eligibility requirements).
• Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.