Massachusetts Licensed Behavioral Health Reviewer

Job Summary

To support timely and appropriate behavioral health services, the full-time salaried Massachusetts Licensed Behavioral Health Reviewer will perform medical necessity reviews, coordinate care with providers, and ensure compliance with regulatory standards in a fully remote environment after onboarding.

Key responsibilities

• Review behavioral health services for medical necessity using established clinical criteria
• Coordinate care with interdisciplinary teams and facilitate referrals to community-based services
• Ensure compliance with NCQA, DOI, and other regulatory requirements through accurate documentation

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