Remote Behavioral Health Utilization Reviewer (MA Licensed)

Baystate Health; United States; Hybrid; USD 90,000 - 122,000; Full time

Job summary

Baystate Health is seeking a Behavioral Health Utilization Management Reviewer to ensure appropriate levels of care and coordinate services for our members. The role involves medical necessity reviews, care coordination with providers, and ensuring regulatory compliance.

Onboarding and training occur at 1 Monarch Place in Springfield, MA; after onboarding, the position is fully remote with MA licensure required to be considered.

Qualifications

• Master’s degree in social work or equivalent behavioral health clinical education.
• Current licensure in MA: LICSW, LCSW, LMHC, Licensed Psychologist, or RN with behavioral health experience.

Responsibilities

• Review medical necessity and conduct utilization management for behavioral health services.
• Coordinate care and collaborate with providers across the continuum of care.
• Assist with care transitions, discharge planning, and referral support.
• Ensure documentation supports clinical decisions and meets regulatory requirements.
• Participate in quality improvement, policy development, and departmental projects.

Skills

Clinical experience

Regulatory knowledge

Communication skills

Care coordination

Education

MSW or equivalent

Tools

Utilization management systems

Job description

Baystate Health is seeking a Behavioral Health Utilization Management Reviewer to ensure appropriate levels of care and coordinate services for our members. The role involves medical necessity reviews, care coordination with providers, and ensuring regulatory compliance.

Onboarding and training occur at 1 Monarch Place in Springfield, MA; after onboarding, the position is fully remote with MA licensure required to be considered.