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Behavioral Health Utilization Management Clinician #26-17648

US Tech Solutions

Role overview

Qualifications

  • Active, unrestricted Massachusetts license as a Registered Nurse (BSN/RN), LICSW, LMHC, or other independently licensed Behavioral Health professional
  • Direct clinical experience in Behavioral Health
  • Experience in Utilization Management, Utilization Review, or Care Management
  • Health Plan or Managed Care experience preferred

Responsibilities

  • Perform behavioral health utilization reviews, concurrent reviews, and prior authorization determinations
  • Review inpatient admissions, outpatient services, specialty referrals, and behavioral health treatment requests using established clinical criteria
  • Determine medical necessity and benefit eligibility, including out-of-network service requests
  • Collaborate with providers, Medical Directors, and care management teams to support timely care decisions

Key facts

Hard skills

Behavioral Health Utilization Management Clinical Assessments Care Management InterQual Criteria Managed Care

Other skills

  • Analytical Skills
  • Communication
  • Organizational Skills

About the company

US Tech Solutions logo

US Tech Solutions

Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

Links

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Job description

Employment Type: 5-month contract with possibility of extension

Job Description
We are seeking a Behavioral Health Utilization Management (UM) Clinician to perform utilization review and medical necessity determinations for behavioral health services. This role partners with providers, care management teams, and medical leadership to ensure members receive appropriate, high-quality, and cost-effective care while maintaining compliance with clinical and regulatory guidelines.

Responsibilities
  • Perform behavioral health utilization reviews, concurrent reviews, and prior authorization determinations
  • Review inpatient admissions, outpatient services, specialty referrals, and behavioral health treatment requests using established clinical criteria
  • Determine medical necessity and benefit eligibility, including out-of-network service requests
  • Collaborate with providers, Medical Directors, and care management teams to support timely care decisions
  • Coordinate referrals and facilitate safe care transitions for members
  • Ensure compliance with regulatory, contractual, and organizational requirements
  • Prioritize authorization requests while meeting productivity and quality expectations
  • Maintain accurate clinical documentation and communicate review outcomes effectively
  • Participate in workflow improvements, departmental initiatives, and ongoing training

Requirements
  • Active, unrestricted Massachusetts license as one of the following:
    • Registered Nurse (BSN/RN)
    • LICSW
    • LMHC
    • Other independently licensed Behavioral Health professional
  • Direct clinical experience in Behavioral Health
  • Experience in Utilization Management, Utilization Review, or Care Management
  • Health Plan or Managed Care experience preferred
  • Experience using InterQual Clinical Criteria preferred
  • Strong clinical assessment, analytical, communication, and organizational skills
  • Ability to work independently in a fast-paced remote environment
Note:
  • Candidates can be remote but must have an Current unrestricted Massachusetts license in a behavioral health area of practice
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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Marcus Rivera

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