Behavioral Health Utilization Manager – Outpatient Services in Boston, Massachusetts - #73036 | VanderHouwen

Description

Job Id: 73036

Behavioral Health Utilization Manager – Outpatient Services
Our client is seeking a Behavioral Health Utilization Manager – Outpatient Services to provide clinical oversight and utilization management for outpatient behavioral health services. This role is ideal for an experienced independently licensed behavioral health professional who brings strong clinical judgment, analytical decision-making, and a collaborative approach to complex cases. The successful candidate will help ensure members receive appropriate, timely care while supporting clinical quality, regulatory compliance, and continuous improvement.

This role is mostly remote with an occasional on-site presence in Charlestown, Massachusetts office and travel within Massachusetts when required.

Behavioral Health Utilization Manager Responsibilities

• Review outpatient and non-24-hour behavioral health service requests and make medical necessity and level-of-care determinations using clinical expertise, established criteria, and individual member needs.
• Manage complex behavioral health cases involving mental health and substance use services, escalating cases to Medical Directors when additional clinical review or consultation is appropriate.
• Identify opportunities for enhanced care coordination, specialized programs, or additional clinical support and facilitate referrals to appropriate internal resources.
• Maintain thorough, accurate, and timely documentation of utilization management decisions in accordance with clinical, operational, and regulatory requirements.
• Collaborate with providers, internal clinical teams, state agencies, and other stakeholders to address clinical questions, resolve concerns, and support effective care delivery.
• Participate in interdisciplinary clinical rounds and case discussions to contribute clinical expertise and support coordinated treatment planning.
• Provide clinical support during crisis situations, applying sound judgment and de-escalation techniques to help members access appropriate resources and stabilization services.
• Monitor utilization and clinical activity for potential indicators of fraud, waste, or abuse and escalate concerns through appropriate channels.
• Partner with clinical leadership to evaluate workflows, identify opportunities for improvement, and strengthen the quality and efficiency of behavioral health utilization management processes.
• Support provider and network-related activities as assigned, which may include collaboration involving child and family behavioral health programs and occasional travel within Massachusetts.
• Contribute behavioral health subject matter expertise to special projects, organizational initiatives, and other clinical priorities as needed.

Behavioral Health Utilization Manager Qualifications

• Active, unrestricted independent clinical license in Massachusetts and/or New Hampshire as an LICSW, LMHC, or LMFT.
• Master’s degree in Social Work, Psychology, Counseling, or a related behavioral health discipline.
• 5–7 years of behavioral health experience within a health insurance, managed care, or similar healthcare environment.
• Demonstrated experience with behavioral health utilization management, including medical necessity reviews and clinical decision-making.
• Strong clinical assessment, critical thinking, problem-solving, and documentation skills with the ability to independently evaluate complex cases.
• Experience with child and adolescent behavioral health and/or substance use disorder services is preferred.
• Knowledge of managed care practices, healthcare regulations, and clinical compliance requirements is preferred.
• Excellent written and verbal communication skills with the ability to collaborate effectively with providers, clinical leaders, internal teams, and external partners.
• Strong organizational and time management skills with the ability to prioritize competing responsibilities in a fast-paced environment.
• Proficiency with Microsoft Outlook, Word, and Excel, along with experience working in clinical or healthcare data management systems.
• Ability to work primarily remotely while attending periodic meetings or training in Charlestown, Massachusetts office and traveling within Massachusetts when required.

Compensation: $40-$45/hr. (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen
What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we’re in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies’ staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

#LI-Remote