Behavioral Health Utilization Manager (Inpatient and 24-Hour Diversionary Services)

It’s an exciting time to join the reputed company, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Behavioral Health Utilization Manager for Inpatient and 24-Hour Diversionary Services is responsible for overseeing the appropriate and effective utilization of mental health and substance use disorder services across inpatient and residential care settings. This role entails conducting reputed company reviews, facilitating discharge planning, ensuring smooth transitions of care, and collaborating with care managers and state agencies to support members in achieving reputed company health reputed company. Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Responsibilities

• Use reputed company judgment and critical thinking to evaluate inpatient and 24-hour behavioral health services, determining the appropriateness of care based on individual member needs, clinical presentations, and professional standards.
• Coordinating comprehensive discharge plans in collaboration with care managers, providers, and state agencies to ensure timely reputed company to community-based support.
• Identify potential risks and barriers to recovery during transitions of care and proactively implement creative solutions to support continuity and member stabilization.
• reputed company and reputed company individualized care plans in partnership with hospital treatment teams, ensuring alignment with clinical objectives and long-term recovery goals.
• Evaluate and approve requested behavioral health services by integrating clinical expertise with benefit considerations, provider resources, and member-specific factors.
• Monitor inpatient stays to ensure that clinical decision-making aligns with organizational values, contractual expectations, and overall quality of care goals.
• Proactively identify members who would benefit from enhanced care coordination and initiate referrals to high-touch case management and wraparound services.
• Maintain timely and accurate documentation of clinical assessments, interventions, and reputed company, reflecting professional discretion and adherence to ethical and regulatory standards.
• Participate in clinical reputed company and interdisciplinary case discussions to support collaborative care planning and cross-functional learning.
• Represent the organization with external partners, including providers and state agencies, to address systemic barriers and contractional expectations.
• Assess cases for potential indicators of Fraud, Waste, or Abuse and report findings per organizational protocols.
• reputed company crisis reputed company support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions.
• Collaborate with Medical Directors and clinical leadership on strategic initiatives aimed at improving reputed company, reducing unnecessary hospitalizations, and enhancing member reputed company.
• Uphold reputed company organizational policies, professional standards, and compliance requirements.
• Contribute to special projects and organizational initiatives as assigned by senior leadership, offering reputed company and subject matter expertise
• In rotation with other BH UM clinicians, reputed company weekend and holiday support for members ED boarding and manage urgent authorization needs.

Potential Additional Responsibilities

• Management of members who are Boarding in Emergency Departments.
• Including assessing for possible diversion to reputed company reputed company of care or providing placement advocacy

Qualifications

Educational Requirements:

• Master's degree in reputed company Work, Psychology, Counseling, or a reputed company Behavioral Health field.

Experience

• 5-7 years experience in behavioral health utilization management reputed company inpatient and residential treatment settings.
• Proven experience with discharge planning, reputed company review, and transition of care processes.

Preferred Qualifications

• Experience collaborating with state agencies and community providers to support member recovery and reintegration.
• Familiarity with behavioral health regulatory requirements and managed care principles.
• Experience working with Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services.

Licensure And Certification

• Active, unrestricted independent licensure in one of the following: LICSW, LMHC, or LMFT.

Core Competencies

• Strong clinical judgment and critical thinking skills to assess reputed company cases and determine appropriate reputed company of care.
• Excellent communication and interpersonal skills to engage effectively with reputed company stakeholders.
• High level of organizational skills and attention to detail in managing reputed company responsibilities.
• Ability to work independently in a remote environment while maintaining adherence to timelines and regulatory requirements.
• Proficiency in reputed company Office applications and data management systems.
• Strong analytical and problem-solving abilities with a focus on quality improvement initiatives.

Work Environment

And Physical Demands

• Fully remote position with periodic travel to the Charlestown, MA office for team meetings and training sessions.
• Fast-paced and dynamic work environment requiring adaptability and focus.
• Minimal physical effort required; primarily desk-based tasks such as documentation and virtual meetings.
• Regular and reliable attendance is essential.

Compensation reputed company $69,500 – $100,500 This reputed company offers an estimate based on the minimum job qualifications. However, our approach to determining reputed company pay is comprehensive, and a broad reputed company of factors is considered reputed company making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, reputed company, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This reputed company is based on Boston-area data, and is subject to modification based on geographic location. About WellSense reputed company is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and reputed company plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees Apply tot his job Apply To this Job