Massachusetts Licensed Behavioral Health Reviewer

Job Summary

To support a growing team, the full-time Massachusetts Licensed Behavioral Health Reviewer will conduct medical necessity reviews, coordinate care, and ensure compliance with regulatory standards while working remotely after initial onsite training.

Key responsibilities

• Review behavioral health services for medical necessity and conduct various types of utilization management reviews
• Collaborate with providers and interdisciplinary teams to coordinate care and facilitate referrals to community services
• Ensure compliance with regulatory requirements and maintain accurate documentation of clinical decisions

Required qualifications

• Master's degree in social work (MSW) or equivalent behavioral health clinical education
• Current licensure in Massachusetts as LICSW, LCSW, LMHC, Licensed Psychologist, or RN with behavioral health experience
• Three to five years of behavioral health clinical experience in settings such as inpatient or outpatient care
• Familiarity with DSM-5 diagnostic criteria and behavioral health medical necessity guidelines
• Experience with electronic utilization management or care management systems