Board Certified Behavior Analyst

Behavioral Health Utilization Management ClinicianWe are seeking a Behavioral Health Utilization Management (UM) Clinician to perform utilization review and medical necessity determinations for behavioral health services. This role partners with providers, care management teams, and medical leadership to ensure members receive appropriate, high-quality, and cost-effective care while maintaining compliance with clinical and regulatory guidelines.ResponsibilitiesPerform behavioral health utilization reviews, concurrent reviews, and prior authorization determinationsReview inpatient admissions, outpatient services, specialty referrals, and behavioral health treatment requests using established clinical criteriaDetermine medical necessity and benefit eligibility, including out-of-network service requestsCollaborate with providers, Medical Directors, and care management teams to support timely care decisionsCoordinate referrals and facilitate safe care transitions for membersEnsure compliance with regulatory, contractual, and organizational requirementsPrioritize authorization requests while meeting productivity and quality expectationsMaintain accurate clinical documentation and communicate review outcomes effectivelyParticipate in workflow improvements, departmental initiatives, and ongoing trainingRequirementsActive, unrestricted Massachusetts license as one of the following: Registered Nurse (BSN/RN)LICSWLMHCOther independently licensed Behavioral Health professionalDirect clinical experience in Behavioral HealthExperience in Utilization Management, Utilization Review, or Care ManagementHealth Plan or Managed Care experience preferredExperience using InterQual Clinical Criteria preferredStrong clinical assessment, analytical, communication, and organizational skillsAbility to work independently in a fast-paced remote environmentNote:Candidates can be remote but must have a current unrestricted Massachusetts license in a behavioral health area of practiceUS Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.By applying, you acknowledge that AI-assisted tools may be used during hiring. #LI-AS140 IND01