Job summary
Job post source
This job is directly from MetroPlusHealth
Job overview
The BH UM Clinician at MetroPlusHealth conducts utilization and quality management activities to manage behavioral health medical costs and ensure high-quality care within the health plan.
Responsibilities and impact
The clinician performs telephonic reviews of inpatient and outpatient services, collaborates with providers and medical directors to determine medical necessity, promotes alternative care options, educates providers, participates in interdisciplinary care team meetings, evaluates housing needs, supports discharge planning, identifies high-risk cases for case management, and contributes to quality improvement and special projects.
Experience and skills
Requires a Master’s Degree, minimum 3 years behavioral health experience in managed care utilization review or related areas, preferably in psychiatric hospital settings, knowledge of integrated care models, chronic condition management, and various clinical tools; LCSW, LMSW, or LMHC license with valid NY State unrestricted license is required; bilingual and quality management experience preferred.
Work environment and culture
MetroPlusHealth emphasizes compassion, collaboration, and empowerment, promoting a supportive environment focused on community health and quality care.
Company information
MetroPlusHealth is a subsidiary of NYC Health + Hospitals, the largest US public health system, providing diverse managed care products and services across New York City with a large network of providers.
Job location and travel
This is a fully remote, project-based position expected to last through April 2026 with possible extension.
Unique job features
This role is distinguished by its focus on behavioral health utilization management within a large public health system, involving interdisciplinary collaboration and telephonic clinical reviews using specialized criteria and tools.
Company overview
MetroPlusHealth is a New York City-based health insurance provider offering a range of plans including Medicaid, Medicare, Child Health Plus, and Marketplace options. They generate revenue through premiums collected from members and reimbursements from government programs. Established in 1985, MetroPlusHealth is a subsidiary of NYC Health + Hospitals, the largest public health care system in the United States. The company is known for its community-focused approach, providing affordable and high-quality health care services to underserved populations.
How to land this job
Tailor your resume to emphasize your experience in behavioral health utilization management, particularly your skills in conducting telephonic reviews using InterQual, LOCADTR, and OMH Criteria Sets, as these are central to the BH UM Clinician role at MetroPlusHealth.
Highlight your expertise in managing medical costs through prospective, concurrent, and retrospective reviews, along with your ability to collaborate with providers and health plan members to promote appropriate care alternatives and compliance.
Apply through multiple platforms including MetroPlusHealth's official corporate career site and LinkedIn to maximize your application visibility and ensure your resume reaches the right recruiters.
Connect with current BH UM Clinicians or team members within MetroPlusHealth on LinkedIn; use ice breakers like asking about their experience with the Integrated Collaborative Care Model or inquiring how they navigate challenges in telephonic utilization reviews.
Optimize your resume for ATS by incorporating keywords from the job description such as 'behavioral health utilization management,' 'InterQual,' 'LOCADTR,' 'medical necessity,' and 'quality assurance' to improve your chances of passing automated screenings.
Leverage Jennie Johnson's Power Apply feature to automate submitting tailored applications across multiple sites, identify and connect with relevant LinkedIn contacts, and optimize your resume for ATS compliance, freeing you to focus on preparing for interviews and networking.
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