HNE Behavioral Health Utilization Management Reviewer
Baystate Health · United States · US
Utilization Review
Remote
physician
Nurse
Demand78
Career growth65
Healthcare fit84
Remote potential90
Salary band
USD 90k – 122k
5-year outlook
Likely stable payer-side utilization management compensation for licensed behavioral health clinicians; advancement may depend on leadership, quality, or regulatory credentials rather than direct clinical productivity. Exact salary is not stated.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-23
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US, GB
- Profession fit
- physician, Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for licensed Massachusetts behavioral health clinicians who want a remote payer-side utilization review role with predictable non-clinical work and strong clinical relevance. Less suitable for those seeking direct patient care or without MA licensure.
Who should apply
LICSWs, LCSWs, LMHCs, licensed psychologists, and RNs with behavioral health experience in Massachusetts who are interested in utilization management, care coordination, and payer compliance.
CV angle
Frame clinical experience around behavioral health assessment, level-of-care determination, interdisciplinary collaboration, documentation, regulatory compliance, appeals, and quality improvement; quantify caseloads, complex transitions, and any utilization or care coordination exposure without inventing UM experience.
Skills to highlight
- Behavioral health clinical assessment
- Medical necessity determination
- Utilization management and pre-authorization
- Care coordination and discharge planning
- NCQA/DOI regulatory compliance
- Clinical documentation and appeals
- Interdisciplinary collaboration
- Quality improvement
Role summary
Payer-side behavioral health utilization management reviewer conducting medical necessity, pre-authorization, concurrent, retrospective, and discharge reviews, coordinating care, supporting appeals, and ensuring NCQA/DOI compliance. Requires active MA behavioral health licensure and 3–5 years clinical experience; remote after onsite training.
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