Utilization Specialist - Hybrid

What You'll Do:In this high-impact role, you will help ensure clients receive the right care at the right time while supporting EMC's commitment to clinical excellence. Your responsibilities will include:Care Coordination & Client Support:

• Coordinate appointments, therapy sessions, referrals, and supportive services 
• Monitor client progress, medication adherence, and engagement in programming
• Partner with families, caregivers, and interdisciplinary teams to ensure continuity of care

• Conduct comprehensive initial and ongoing assessments
• Support clients with the individualized recovery plans and evidence-based coping strategies
• Serve as an internal resource on medical necessity, utilization workflows, and clinical best practices

• Lead prior authorizations, concurrent reviews, and discharge planning
• Ensure full compliance with payer guidelines, authorization limits, Medicaid/Medicare rules, and regulatory requirements
• Coach and train team members on documentation, compliance standards, and evolving regulations
• Review utilization trends and recommend process improvements or efficiencies

• Maintain accurate, timely documentation in the EHR and complete required assessments (CANS/ANSA)
• Prepare and submit monthly utilization and outcomes reports
• Participate in monthly UM meetings, audits, and continuous quality improvement initiatives
• Consistently uphold HIPAA and all state/federal behavioral health regulations

• Respond to call-outs, client emergencies and inquiries in alignment with protocols, including occasional after-hours support
• Support clinic outreach through community engagement, referral coordination, and collaboration with external partners 
• Perform other duties as assigned

Minimum Qualifications:

• Bachelor’s degree in psychology, sociology, criminal justice, education or other related field (Master’s degree preferred)
• Active QMHP certification and HIPAA training
• CANS/ANSA certification (or willing to obtain)
• At least one year experience in behavioral health, case management or a clinical support role (2-3 years in a utilization management role preferred)
• Strong understanding of managed care, medical necessity criteria, and Medicaid authorizations
• Excellent documentation, assessment and critical-thinking skills
• Ability to collaborate effectively across clinical and administrative teams

Who Thrives in This Role:You'll be a strong fit for EMC if you are:

• Mission-driven and committed to compassionate, high-quality care
• A confident communicator who builds rapport easily
• Detail-oriented, organized, and comfortable balancing multiple priorities
• Skilled at blending clinical judgment and operational decision-making
• Dedicated to ethical practice and ongoing professional development

• Make a meaningful difference in clients' lives every day
• Join a collaborative, supportive clinical team
• Access opportunities for professional growth, mentorship, and certification
• Be a part of a mission-driven organization that truly values quality, compassion, and innovation 

• Full-time, Monday-Friday with limited on-call responsibilities
• Hybrid clinical/administrative position in an outpatient behavioral health setting
• 2 days onsite in our Northwest Houston office
• Requires regular use of EHR systems, reporting tools, and standard office equipment

• $52,000 to $65,000 per year, depending on education and experience
• Group Health insurance options, both employee and employer paid
• Paid Time Off

Equal Opportunity Employer:EMC Behavioral Health is an Equal Opportunity Employer and is committed to fostering a diverse, inclusive, and equitable work environment. We welcome applicants of all backgrounds, identities, and experiences.

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