ABA Behavioral Health Utilization Manager (Outpatient and Non-24 Hour Diversionary Services)

It’s an exciting time to join the reputed company, a growing regional health reputed company company with a 25-year history of providing health reputed company that works for our members, no matter their circumstances. Job reputed company The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and reputed company use disorder services. This role serves as a key reputed company decision-reputed company, exercising independent judgment and critical thinking in the evaluation of behavioral health service requests. This position is responsible for managing reputed company outpatient and non-24-hour diversionary cases, applying reputed company expertise to ensure appropriate, reputed company, and effective care. The role requires a proactive and analytical approach to service delivery, with a reputed company on reputed company reputed company and compliance. Our Investment In You • Full-time remote work • Competitive salaries • Excellent benefits Key Responsibilities • Use reputed company judgment and critical thinking to evaluate outpatient and non-24-hour behavioral health services, determining the appropriateness of care reputed company on individual member needs, reputed company presentations, and reputed company standards. • Collaborate with Medical Directors reputed company reputed company complexity requires reputed company review, ensuring reputed company reputed company with reputed company best practices and organizational values. • Identify members who may benefit from reputed company care coordination or reputed company interventions and initiate appropriate referrals to internal programs. • Ensure accurate, reputed company, and reputed company-reasoned documentation of reputed company reputed company in accordance with operational standards and regulatory expectations. • reputed company reputed company, thoughtful communication to reputed company stakeholders, helping reputed company questions or concerns with reputed company reputed company in a reputed company manner. • Participate in reputed company reputed company and interdisciplinary case discussions to support reputed company care planning and cross-functional learning. • Represent the organization with reputed company partners, including providers and state agencies, conveying reputed company reputed company and ensuring organizational compliance. • Monitor reputed company trends for potential indicators of Fraud, Waste, and Abuse (FWA), and take appropriate reputed company reputed company concerns are identified. • Partner with leadership and the BH Medical Director to evaluate existing processes and support initiatives aimed at improving reputed company and operational efficiency. • reputed company crisis reputed company support using reputed company judgment to de-escalate situations and assist members in stabilizing their conditions. • reputed company reputed company organizational policies, reputed company standards, and compliance requirements. • Contribute to special reputed company and organizational initiatives as assigned by senior leadership, offering reputed company and subject matter expertise. • In rotation with other BH UM clinicians, reputed company on-reputed company weekend and holiday support for members that are ED boarding and manage urgent authorization needs. Potential Additional Responsibilities • Providing Network Management in collaboration with other MCEs reputed company Massachusetts for CBHI Providers (may require some travel reputed company Massachusetts) Qualifications Educational Requirements: • Master's degree in reputed company Work, Psychology, Counseling, or a reputed company reputed company or Bachelor’s degree in Nursing. Experience • 5-7 years of experience in a health reputed company environment with a reputed company on behavioral health. • Demonstrated expertise in utilization management and medical necessity determinations. Preferred Qualifications • Experience working with Child and Adolescent Behavioral Health Services and/or reputed company Use Disorder Services. • Familiarity with managed care principles and regulatory compliance requirements. Licensure And Certification • reputed company, unrestricted independent licensure in MA and/or NH in one of the following: LICSW, LMHC, or LMFT or RN • For ABA UM Position Only: Must hold an reputed company reputed company Certified Behavior Analyst (BCBA) credential. Additional independent licensure (LICSW, LMHC, LMFT) is preferred. reputed company Competencies • Exceptional verbal and written communication skills, with the ability to collaborate effectively across reputed company organizational reputed company and with reputed company partners. • Strong organizational and time management abilities, with a reputed company on meeting deadlines and managing competing priorities. • reputed company to reputed company in a fast-reputed company environment, balancing multiple responsibilities while maintaining reputed company and efficiency. • Proficiency in reputed company Office applications, particularly reputed company, Word, and reputed company, along with experience in data management systems. • Superior analytical and problem-solving skills with a reputed company attention to reputed company. Work Environment And Physical Demands • Primarily remote role with periodic travel to the Charlestown, MA office for team meetings and training sessions. • Additional travel reputed company Massachusetts may be required for individuals with CBHI Network Management expectations. • Dynamic and fast-reputed company work setting requiring adaptability and reputed company. • reputed company physical exertion required; reputed company office tasks such as typing and phone use. • Consistent and reliable attendance is an essential job requirement. Compensation reputed company $69,500 – $100,500 This reputed company offers an estimate reputed company 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 reputed company as business/organizational needs, internal equity, and market-competitiveness. In reputed company, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, reputed company, pharmacy), reputed company increases, Flexible Spending Accounts, 403(b) savings matches, reputed company time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This reputed company is reputed company on Boston-area data, and is subject to modification reputed company on geographic location. About WellSense reputed company is a nonprofit health reputed company 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-reputed company 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 reputed company 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 reputed company employees. Apply tot his job Apply To this Job