Utilization Management Nurse Position Available In Broward, Florida

Utilization Management Behavioral Health Clinician Utilization Management Behavioral Health Clinician We’re seeking a dedicated Behavioral Health Clinician to join our Utilization Management team. In this role, you’ll collaborate with an interdisciplinary team to review and authorize behavioral health and substance use services, ensuring appropriate care and resource utilization.

Key Responsibilities:

Conduct utilization reviews and service authorizations for behavioral health and substance use treatments. Coordinate care for members in crisis, including triage, discharge planning, and aftercare referrals. Review treatment plans and collaborate with Medical Directors on medical necessity. Ensure compliance with state, federal, and contractual guidelines. Serve as a liaison between providers, members, and internal teams. Promote safe transitions of care and optimal resource use.

Qualifications:

Degree in nursing or behavioral health field. Active Florida license (RN, LCSW, LMSW, LPHA, or LMHC). 2+ years in utilization review/case management; 1+ year in acute care discharge planning preferred. 5-7 years of clinical experience. Familiarity with InterQual, ASAM, Milliman, CMS, and Florida Medicaid guidelines. Strong communication, critical thinking, and documentation skills.

Additional Requirements:

Valid Florida driver’s license. Proficiency in EMR systems and Microsoft Office. Ability to work independently and occasionally on weekends. Work Environment The role offers a hybrid work schedule post-training, with hours from Monday to Friday, 8am-5pm.