Banner Health is hiring a Behavioral Health Utilization Care Manager

Banner Health is hiring a Behavioral Health Utilization Care Manager to serve as the point person for utilization activities for assigned members. In this role, you will authorize initial admissions and conduct concurrent reviews for medical necessity at various hospitals, working closely with facilities and outpatient providers.

What You'll Do

• Review and authorize behavioral health and substance abuse services in inpatient, residential, and outpatient settings using approved medical necessity criteria.
• Monitor care to ensure treatment is appropriate and effective.
• Assess the member’s plan of care and develop, implement, monitor, and document the utilization of resources and progress of the member through their care.
• Facilitate options and services to meet the member’s health care needs.
• Provide telephonic or electronic document review.
• Engage internal and external resources to ensure members receive appropriate care plan and discharge planning services.
• Monitor for quality of care concerns and staff regularly with medical directors.
• Provide education and recommend alternative care plans for treatment not meeting medical necessity criteria.
• Identify and resolve barriers which may hinder effective care delivery to members.
• Conduct prior authorization, concurrent, retrospective, and appeal reviews.
• Manage individual members across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.
• Act in a leadership function with process improvement activities for populations of patients.
• Establish and promote collaborative relationships with physicians, other payers, and other members of the health care team.
• Collect and communicate pertinent, timely information to fulfill utilization and regulatory requirements.
• Act in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan.
• Educate internal members of the health care team on case management and managed care concepts.

What We're Looking For

• Master’s degree in social work, counseling or related field or independent/associate licensure.
• Licensure in at least one of the following categories as required by state law: Social work, professional counseling, or marriage and family (LCSW, LMSW, LPC, LAC, or Licensed Psychologist).
• Three years of clinical experience (i.e., counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
• Working knowledge of care management, case management, hospital and community resources.
• Critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
• Ability to work effectively independently and in an interdisciplinary team format.
• Arizona residency for compliance.

Nice to Have

• Previous experience with behavioral health utilization management.
• Additional related education and/or experience.

Team & Environment

You will be part of an interdisciplinary team, collaborating to ensure members receive coordinated and effective care.

Compensation

• Pay: $27.72 - $46.20 / hour, based on location, education, and experience.

Work Mode

This is a remote position requiring Arizona residency.

Banner Health was recognized on Becker's Healthcare 2025 list of 150+ top places to work in healthcare. We are committed to supporting team members through comprehensive benefits, opportunities for growth, inclusive and empowering work environments, and resources that promote a healthy work-life balance.

Our organization is an equal opportunity employer. We support a drug-free work environment.