Board Certified Behavior Analyst

Behavioral Health Utilization Management Clinician

We 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.

Responsibilities

• Perform behavioral health utilization reviews, concurrent reviews, and prior authorization determinations
• Review inpatient admissions, outpatient services, specialty referrals, and behavioral health treatment requests using established clinical criteria
• Determine medical necessity and benefit eligibility, including out-of-network service requests
• Collaborate with providers, Medical Directors, and care management teams to support timely care decisions
• Coordinate referrals and facilitate safe care transitions for members
• Ensure compliance with regulatory, contractual, and organizational requirements
• Prioritize authorization requests while meeting productivity and quality expectations
• Maintain accurate clinical documentation and communicate review outcomes effectively
• Participate in workflow improvements, departmental initiatives, and ongoing training

Requirements

• Active, unrestricted Massachusetts license as one of the following:
  • Registered Nurse (BSN/RN)
  • LICSW
  • LMHC
  • Other independently licensed Behavioral Health professional
• Direct clinical experience in Behavioral Health
• Experience in Utilization Management, Utilization Review, or Care Management
• Health Plan or Managed Care experience preferred
• Experience using InterQual Clinical Criteria preferred
• Strong clinical assessment, analytical, communication, and organizational skills
• Ability to work independently in a fast-paced remote environment

Note:

• Candidates can be remote but must have a current unrestricted Massachusetts license in a behavioral health area of practice

US 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.

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