Remote Behavioral Health Utilization Manager

WellSense Health Plan; Boston (MA); A distancia; USD 70.000 - 101.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Full-time remote work

Competitive salaries

Excellent benefits

Descripción de la vacante

WellSense Health Plan, a Massachusetts-based nonprofit health insurer, is seeking a Behavioral Health Utilization Manager. This role requires clinical judgment to assess outpatient behavioral health services and ensure timely, appropriate care while complying with standards.

The role supports remote work, offers competitive pay, and excellent benefits. Candidates should bring licensure in MA/NH and 5–7 years in health insurance with behavioral health focus.

Formación

• Master's degree in Social Work, Psychology, Counseling, or related Behavioral Health field.
• Active, unrestricted independent licensure in MA and/or NH (LICSW, LMHC, LMFT or RN).
• 5–7 years of experience in a health insurance environment with a focus on behavioral health.
• Demonstrated expertise in utilization management and medical necessity determinations.

Responsabilidades

• Use advanced clinical judgment to evaluate outpatient and non-24-hour behavioral health services and determine appropriateness of care.
• Collaborate with Medical Directors for complex cases and reviews.
• Identify members who may benefit from enhanced care coordination or specialized interventions.
• Document clinical decisions accurately and in a timely manner.

Conocimientos

Verbal and written communication

Organizational and time management

Analytical thinking / problem solving

Data management

Microsoft Office (Outlook, Word, Excel

Educación

Master's degree in Social Work, Psychology, Counseling, or related Behavioral Health field

Bachelor’s degree in Nursing

Herramientas

Microsoft Office Suite

Descripción del empleo

WellSense Health Plan, a Massachusetts-based nonprofit health insurer, is seeking a Behavioral Health Utilization Manager. This role requires clinical judgment to assess outpatient behavioral health services and ensure timely, appropriate care while complying with standards.

The role supports remote work, offers competitive pay, and excellent benefits. Candidates should bring licensure in MA/NH and 5–7 years in health insurance with behavioral health focus.