Remote Behavioral Health Utilization Manager – Outpatient

WellSense Health Plan; Northern (KY); Hybrid; USD 70,000 - 101,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

403(b) matches

Paid time off

Career advancement opportunities

Wellbeing resources

Job summary

WellSense Health Plan is seeking a Behavioral Health Utilization Manager to oversee outpatient and non-24 hour diversionary services. You will be a key clinical decision-maker evaluating service requests and managing complex cases with a proactive, analytical approach.

This primarily remote role involves collaboration with Medical Directors, care coordination, and external partner engagement, with occasional travel to Massachusetts locations as needed.

Qualifications

• Master's degree in Social Work, Psychology, Counseling, or related Behavioral Health field; or Bachelor’s degree in Nursing.
• 5–7 years of experience in a health insurance environment with a focus on behavioral health.
• Active, unrestricted licensure in MA and/or NH (LICSW/LMHC/LMFT or RN); BCBA credential for ABA UM position.

Responsibilities

• Evaluate outpatient and non-24-hour behavioral health services for appropriateness of care based on member needs, clinical presentations, and professional standards.
• Collaborate with Medical Directors for clinical complexity reviews to ensure alignment with best practices.
• Identify members who may benefit from enhanced care coordination or specialized interventions and initiate referrals.
• Ensure accurate, timely documentation of clinical decisions per standards and regulatory expectations.
• Provide crisis intervention support and de-escalation using clinical judgment.
• Represent the organization with external partners and stakeholders to convey clinical insight and ensure compliance.

Skills

Utilization management

Clinical judgement

Communication

Analytical thinking

Documentation

Collaboration

Education

Master's degree in Social Work

Master's degree in Psychology

Master's degree in Counseling

Bachelor of Science in Nursing

Tools

Microsoft Office

Data management systems

Job description

WellSense Health Plan is seeking a Behavioral Health Utilization Manager to oversee outpatient and non-24 hour diversionary services. You will be a key clinical decision-maker evaluating service requests and managing complex cases with a proactive, analytical approach.

This primarily remote role involves collaboration with Medical Directors, care coordination, and external partner engagement, with occasional travel to Massachusetts locations as needed.