Health consultant Jobs in Phoenix, AZ

Our Client, a Retail Pharmacy company, is looking for a LCSW / LPC / LMFT or RN (Utilization Management Clinical Consultant – Behavioral Health) for their Phoenix, AZ location.

Responsibilities :

• Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.
• Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks.
• Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions.
• Conduct concurrent reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care.
• Identify members who may benefit from care management programs and facilitate appropriate referrals.
• Provide urgent or emergent clinical interventions when required, including triage and crisis support.
• Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care.
• Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
• Develop and support initiatives that enhance quality effectiveness and benefit utilization.
• Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.
• Primarily sedentary, desk-based role involving extended periods of sitting, talking, and focused review work.
• The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child / adolescent members.
• This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication.

Client Utilization Management

Requirements :

Why Should You Apply?

Health Benefits

Referral Program

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.