Behavioral Health Utilization Manager

Description

The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and substance use disorder services. This role serves as a key clinical decision-maker, exercising independent judgment and critical thinking in the evaluation of behavioral health service requests. This position is responsible for managing complex outpatient and non-24-hour diversionary cases, applying clinical expertise to ensure appropriate, timely, and effective care. The role requires a proactive and analytical approach to service delivery, with a focus on clinical quality and compliance.

Key Responsibilities:

• Use advanced clinical judgment and critical thinking to evaluate outpatient and non-24-hour behavioral health services, determining the appropriateness of care based on individual member needs, clinical presentations, and professional standards.
• Collaborate with Medical Directors when clinical complexity requires further review, ensuring decisions align with clinical best practices and organizational values.
• Identify members who may benefit from enhanced care coordination or specialized interventions and initiate appropriate referrals to internal programs.
• Ensure accurate, timely, and well-reasoned documentation of clinical decisions in accordance with operational standards and regulatory expectations.
• Provide clear, thoughtful communication to internal and external stakeholders, helping resolve questions or concerns with clinical insight in a timely manner.
• Participate in clinical rounds and interdisciplinary case discussions to support collaborative care planning and cross-functional learning.
• Represent the organization with external partners, including providers and state agencies, conveying clinical insight and ensuring organizational compliance.
• Monitor clinical trends for potential indicators of Fraud, Waste, and Abuse (FWA), and take appropriate action when concerns are identified.
• Partner with leadership and the BH Medical Director to evaluate existing processes and support initiatives aimed at improving quality and operational efficiency.
• Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions.
• Uphold all organizational policies, professional standards, and compliance requirements.
• Contribute to special projects and organizational initiatives as assigned by leadership, offering insight and subject matter expertise.

Potential Additional Responsibilities

• Providing Network Management in collaboration with other MCEs within Massachusetts for CBHI Providers (may require some travel within Massachusetts)

Additional Skills & Qualifications

Educational Requirements:

• Master"s degree in Social Work, Psychology, Counseling, or a related Behavioral Health field.

Experience:

• 5-7years of experience in a health insurance environment with a focus 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 Substance Use Disorder Services.
• Familiarity with managed care principles and regulatory compliance requirements.

Licensure and Certification:

• Active, unrestricted independent licensure in Massachusetts and/or New Hampshire in one of the following: LICSW, LMHC, or LMFT.
• For ABA UM Position Only: Must hold an active Board Certified Behavior Analyst (BCBA) credential. Additional independent licensure (LICSW, LMHC, LMFT) is preferred.

Core Competencies:

• Exceptional verbal and written communication skills, with the ability to collaborate effectively across all organizational levels and with external partners.
• Strong organizational and time management abilities, with a focus on meeting deadlines and managing competing priorities.
• Capacity to thrive in a fast-paced environment, balancing multiple responsibilities while maintaining accuracy and efficiency.
• Proficiency in Microsoft Office applications, particularly Outlook, Word, and Excel, along with experience in data management systems.
• Superior analytical and problem-solving skills with a keen attention to detail.

Job Type & Location

This is a Contract position based out of Boston, MA.

Pay and Benefits

The pay range for this position is $40.00 - $45.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jul 14, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.