Utilization Review Clinical Specialist

Job overview

The Utilization Review Clinical Specialist works onsite in Plattsburgh, NY, and earns $75,000 per year. Behavioral Health Services North provides whole-person care in the region. The specialist reviews clinical utilization to assess medical necessity and appropriate levels and intensity of care. Through consultation with treatment teams and attention to access, quality, outcomes, and regulatory requirements, the role supports effective service delivery and continuity of care.

What you'll do

• Conduct prospective, concurrent, retrospective, and continued-stay reviews
• assess medical necessity, clinical appropriateness, level of care, service intensity, frequency, and duration
• identify underutilization, overutilization, and changes in clinical need
• recommend level-of-care changes
• consult with supervisors and treatment teams
• identify engagement barriers and collaborate on outreach and care planning
• review utilization across disciplines and levels of care.

What we're looking for

Skills & competencies

full-time

utilization review clinical specialist

plattsburgh ny

behavioral health

clinical utilization review

medical necessity

care coordination

monday–friday

8:30am–4:30pm

master’s degree

new york state license

$75k/year

Work arrangement

• Weekend coverage required

Benefits & perks

• Health coverage, paid time off, holiday pay, training opportunities, community discounts, and loan forgiveness.

Why this role

Monday–Friday, 8:30 a.m.–4:30 p.m. Requires a master’s degree and current New York State license in a listed behavioral health discipline or a closely related field.

About the employer

Behavioral Health Services North Inc is hiring for this role. Industry: Outpatient Mental Health and Substance Abuse Centers. Sector: 62.