85 Best data analyst Jobs in Fort Lauderdale, Florida (November 2025)

South Florida Community Care Network LLC

Utilization Management Behavioral Health Clin

17 days ago

Fort Lauderdale

Job Description Hybrid-Sunrise, Florida Position Summary: The Utilization Management Behavioral Health Clinician works under general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration with the interdisciplinary team. The primary responsibilities are to perform the review of requests for behavioral health, substance use , and applied behavioral analysis service authorizations in order to assist with utilization of appropriate services. These reviews include, but are not limited to, selected behavioral health and substance use treatments and services, hospital admissions, rehabilitative and ancillary services, and out-of-plan referrals. This individual will assist with complex cases and internal process development and interacts closely with the BH Medical Director and other Medical Management staff to direct appropriate utilization and data capture. The clinician will provide education to physicians and other members of the team on the issues related to utilization review, including inappropriate admissions and placements. The Utilization Management Behavioral Health Clinician is also responsible for managing continuity of care, ensuring smooth and safe transitions, provider and patient satisfaction, patient safety and appropriate length of stay. Essential Duties and Responsibilities: • Conducts all necessary direct utilization management activities for behavioral health plan members, pre-certification and authorization of care for both psychiatric and chemical dependency services, all necessary concurrent review with hospitals and mental health centers, discharge and aftercare planning and referrals for continued outpatient care., • Review ABA therapy service requests for medical necessity based on clinical guidelines, • Apply expertise in behavior analysis to make determinations on treatment plans, prior authorizations, re-authorizations, and concurrent reviews., • Maintain current knowledge of ABA best practices, managed care policies, and state/federal regulations., • Reviews prior authorization requests for medical necessity and appropriateness, utilizing standardized review criteria; coordinates with the BH Medical Director/Physicians for those requests outside of standard review criteria., • Interacts with hospital representatives and attending psychiatrists and coordinates physician-to-physician reviews with the medical director. Reviews treatment plans and consults with medical director regarding medical necessity criteria for continued inpatient stay. Facilitates community placements, agency linkages and coordinates discharge planning, aftercare, referral and follow-up of inpatients in collaboration with C3 case managers., • Maintains compliance with federal and state guidelines, as well as contractual requirements as determined by line of business; this includes coordinating with the Medical Director to ensure requests are processed timely., • Obtains necessary documentation and ensures completion of assigned caseload by addressing discrepancies and following up until a determination is achieved., • Serves as a liaison between the Medical Director, physicians and office staff in resolving prior authorization questions, issues and problems; communicates denial determinations to providers when indicated., • Performs evaluation and concurrent monitoring of appropriate utilization of resources including, but not limited to, hospitalizations, outpatient services and long-term rehabilitation., • Provides current and timely documentation reflecting department work processes and policy guidelines., • Promotes safe and appropriate coordination of care., • Promotes, facilitates, and controls the optimal utilization of resources, consistent with organizational goals., • Identifies and participates in the development of programs, policies, and procedures to promote continuous quality improvement., • Assures adherence to company and department policies and procedures regarding confidentiality., • Participates in regular departmental training., • Serves as a plan liaison to coordinate enrollee benefits with providers and /or external organizations. Qualifications: • Degree in nursing in behavioral health related field., • Current unrestricted Florida License (RN, LCSW or LMSW)., • Board Certified Behavior Analyst (BCBA) in good standing., • Master’s degree in Behavior Analysis, Psychology, Special Education, or related field., • Minimum of 3 years of clinical ABA experience, including treatment planning and supervision, • Strong understanding of insurance-based ABA treatment models and documentation standards, preferred., • Minimum of two years of utilization review/case management experience and a minimum of one year of experience in discharge planning in an acute care setting highly desirable., • Five to seven years related clinical experience in a healthcare field; or equivalent combination of education and experience., • Valid Florida Driver’s License., • Knowledge of case management and utilization review concepts, including but not limited to, InterQual, Milliman Criteria, Florida Medicaid Program, American Society of Addiction Medicine (ASAM) and CMS Guidelines., • Knowledgeable regarding community and post-acute resources and related requirements., • Proficient in word processing software, spreadsheet software such as Microsoft Excel, and electronic medical record software. Skills and Abilities: • Superior clinical skills to determine appropriate clinical and other information for medical necessity reviews and identify appropriate mechanism to address delays or variation for expected care practices., • Familiarity with Florida Medicaid Coverage Handbooks, NCQA, AAAHC and URAC compliance standards, • Strong analytical and documentation skills, • Critical thinking and problem-solving skills., • Ability to work in a fast-paced environment., • Ability to be self-directed and work independently with decision making skills., • Ability to demonstrate flexibility with changing priorities., • Professionalism., • Ability to communicate effectively with diverse populations., • Ability to maintain confidentiality at all times. Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

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