To support timely and appropriate behavioral health services, the full-time salaried Massachusetts Licensed Behavioral Health Reviewer will perform medical necessity reviews, coordinate care with providers, and ensure compliance with regulatory standards in a fully remote workplace after onboarding.
Key responsibilities Review behavioral health services for medical necessity using established clinical criteria Coordinate care with interdisciplinary teams and facilitate referrals to community-based services Ensure compliance with NCQA, DOI, and other regulatory requirements through accurate documentation Required qualifications Master's degree in social work (MSW) or equivalent behavioral health clinical education Current licensure in Massachusetts as LICSW, LCSW, LMHC, Licensed Psychologist, or RN with behavioral health experience Three to five years of behavioral health clinical experience in settings such as inpatient or outpatient care Familiarity with DSM-5 diagnostic criteria and behavioral health medical necessity guidelines Experience with electronic utilization management or care management systems