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Healthcare Consultant III - Utilization Management Clinical Consultant – Behavioral HealthUS Tech Solutions • New Jersey, NJ, US
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Healthcare Consultant III - Utilization Management Clinical Consultant – Behavioral Health

Healthcare Consultant III - Utilization Management Clinical Consultant – Behavioral Health

US Tech Solutions • New Jersey, NJ, US
30+ days ago
Job type
  • Full-time
Job description


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
  • Collaborate with healthcare providers and internal teams to ensure timely authorization and care coordination
  • Identify members who may benefit from care management programs and initiate referrals
  • Provide urgent clinical interventions, including triage and crisis support when necessary
  • Promote cost-effective care by identifying opportunities to optimize resource utilization
  • Educate providers on utilization management processes and documentation standards
  • Prepare clinical reports, maintain accurate documentation, and track key performance indicators

Required Qualifications

  • Master’s degree for behavioral health clinicians ( LCSW, LPC, LMFT) OR Associate’s degree for Registered Nurses (RN)
  • Strong knowledge of behavioral health terminology and utilization management principles
  • Experience reviewing clinical documentation and applying medical necessity criteria
  • Excellent critical thinking, analytical, and decision-making skills
  • Strong communication skills with providers, members, and cross-functional teams
  • Ability to handle confidential information with professionalism and integrity
  • Comfortable working in a virtual, desk-based environment


About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran

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Healthcare Consultant III - Utilization Management Clinical Consultant – Behavioral Health • New Jersey, NJ, US

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