Eduvention Mentoring and Consulting

Utilization Specialist - Hybrid

Clinical Services - Houston, TX - Full Time

At EMC Behavioral Health, we believe mental health begins with passionate care, intentional connection and the power of evidence-based practice. Guided by our mission to deliver the highest quality, client-centered care and our vision to equip individuals with innovative tools for lasting mental wellness, we serve as a trusted partner to clients, families, and communities seeking meaningful change. If your driven by purpose, energized by advocacy, and committed to ensuring that care is both clinically sound and deeply human, you will find your calling here at EMC.

Position Summary:
The Utilization Specialist is a key driver of EMC's clinical excellence, ensuring each client receives timely, appropriate, and medically necessary care. This role seamlessly integrates care coordination, clinical assessment, and utilization management to support strong recovery outcomes, uphold regulatory and payer requirements, and strengthen overall operational efficiency.  We're seeking a clinically grounded professional with sharp analytical insight, exceptional communication skills, and a genuine commitment to serving diverse populations within a dynamic behavioral health setting. 

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
Clinical Assessment & Treatment Planning:
  • 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
Utilization Review & Case Management:
  • 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
Documentation, Reporting & Compliance:
  • 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
Additional Responsibilities:
  • 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
Why Join EMC Behavioral Health:
  • 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 
Schedule & Work Environment:
  • 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
Compensation & Benefits:
  • $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.

Apply: Utilization Specialist - Hybrid
* Required fields
First name*
Last name*
Email address*
Location
Phone number*
Resume*

Attach resume or Paste resume

Attach resume as .pdf, .doc, .docx, .odt, .txt, or .rtf (limit 5MB) or paste resume

Paste your resume here or attach resume file

Do you possess a Bachelor’s degree or higher in Psychology, Sociology, Criminal Justice, Education, or a related field?*
If you answered "yes" to the question above, please specify your degree and area of study:
Which of the following certifications do you currently hold? (Select all that apply)*
If you answered "other" to the question above, please specify your other certifications:
How many years of experience do you have in behavior support or related clinical setting working with all age groups?*
Describe your experience working in a behavioral health or clinical setting, including the types of clients or programs you have supported.*
How many years of experience do you have performing utilization management, including but not limited to utilization review, prior authorizations, or medical necessity determinations?*
Describe your experience conducting or reviewing clinical assessments, treatment plans, or reassessments for behavioral health clients.*
Give an example of how you have coordinated care or facilitated communication among clients, families, and multiple service providers.*
Rate your knowledge of Medicaid, Medicare, and managed care payer regulations (e.g., NCQA, URAC, HIPAA).*
Provide an example of how you've applied this knowledge in practice.*
Which Electronic Health Record (EHR) or data reporting systems have you used? Describe your level of proficiency.*
This role may require availability during non-traditional hours for urgent or crisis situations. Are you able and willing to provide on-call or flexible availability, if needed?*
If you answered "maybe" to the question above, please explain:
What interests you most about the Utilization Specialist position and how does it align with your professional goals?*
This is a hybrid position, are you willing and available to work on-site in our Northwest Houston office two days a week?*
Are you legally authorized to work in the United States?*
Are you bilingual, fluent English and Spanish?*
When are you available to start?*
Please provide the name, email address, and phone number for three professional references.

(Note: We will notify you before contacting any of your references.)
Human Check*