[Remote] 'Utilization Management Clinical – Behavioral Health Consultant' : Work From Home

Note: The job is a remote job and is open to candidates in USA. LanceSoft Inc. is seeking a Utilization Management Clinical Consultant specializing in Behavioral Health. This remote role involves applying clinical expertise to assess the medical necessity and appropriateness of behavioral health services, while collaborating with healthcare providers and stakeholders to ensure quality care and effective resource utilization. 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 Skills • Must have an active AZ Licensed Clinical Social Worker (LCSW) OR Licensed Professional Counselor (LPC) OR Licensed Marriage and Family Therapist (LMFT) OR will consider RNs with an active compact license who focus in BH • Experience performing behavioral health utilization management or clinical reviews • Experience using medical necessity criteria such as InterQual, MCG, ASAM, or LOCUS • Clinical experience with adults, child/adolescent, or both • Experience communicating with providers or clinical teams regarding authorizations or care coordination • Ability to work Monday–Friday, 8am–5pm Arizona time, and open to occasional holiday/weekend rotation • Must have a private, quiet workspace suitable for confidential review work • Working knowledge of behavioral health terminology, clinical documentation, and utilization management principles • Strong critical thinking, problem-solving, and decision-making skills • Ability to evaluate clinical needs while balancing quality, cost, and member-centered care • Effective communication skills with diverse clinical staff, members, and community partners • Ability to handle sensitive and confidential information ethically and responsibly • Digital literacy and ability to function effectively in a virtual, desk-based work environment • Cultural competence and ability to work with diverse populations and interdisciplinary teams • Master's degree required for behavioral health clinicians (LCSW, LPC, LMFT) or Associate's degree required for RN applicants Company Overview • Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. It was founded in 2000, and is headquartered in Herndon, Virginia, US, with a workforce of 5001-10000 employees. Its website is https://www.lancesoft.com. Company H1B Sponsorship • LanceSoft Inc., has a track record of offering H1B sponsorships, with 55 in 2025, 32 in 2024, 23 in 2023, 25 in 2022, 60 in 2021, 80 in 2020. Please note that this does not guarantee sponsorship for this specific role.