Behavioral Health Utilization Manager (Outpatient Services)

Our client is seeking a thoughtful and analytical Behavioral Health Utilization Manager who brings strong clinical judgment, attention to detail, and a collaborative mindset to complex outpatient care decisions. This individual thrives in a fast-paced environment, communicates effectively across stakeholders, and takes a proactive approach to improving care quality and operational efficiency. The ideal candidate is adaptable, solutions-oriented, and committed to delivering high-quality behavioral health outcomes. This role is primarily remote with periodic travel to Boston, Massachusetts.

Responsibilities

• Evaluate outpatient behavioral health service requests using clinical judgment to ensure appropriate and effective care.
• Collaborate with clinical leadership and interdisciplinary teams to support complex case decisions and care planning.
• Identify members needing enhanced support and coordinate referrals to appropriate programs or services.
• Maintain accurate, timely documentation and ensure compliance with regulatory and organizational standards.
• Monitor trends, support quality improvement initiatives, and address potential risk areas such as fraud, waste, and abuse.

Qualifications

• Master’s degree in Social Work, Counseling, Psychology, or a related behavioral health field.
• 5–7 years of experience in behavioral health within a managed care or health insurance setting.
• Demonstrated experience with utilization management and medical necessity determinations.
• Active, unrestricted independent licensure in Massachusetts or New Hampshire (e.g., LICSW, LMHC, or LMFT).
• Strong communication, organizational, and analytical skills with the ability to manage competing priorities effectively.

Pay

$40–$45/hr (DOE)

Benefits

• Medical, dental, and vision insurance
• Life insurance
• Short- and long-term disability
• Matching 401(k)