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Behavioral Health Utilization Management Jobs in Massachusetts

MiraVista

Utilization Review Clinician

Holyoke, MA

... MiraVista Behavioral Health Center. The Utilization Review Clinician will have the following: * Master's level clinician or RN. * Previous utilization management, preferably in an inpatient ...

Socket.dev

Behavioral Health Director

Greenfield, MA · On-site

$140 - $195/hr

Develops and manages the Behavioral Health Department annual operating budget in collaboration with organizational leadership. * Monitors financial performance, resource utilization, and ...

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Molina Healthcare

Auditor, Healthcare Services

Waltham, MA · On-site

$30.37 - $59.21/hr

Essential Job Duties Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

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All JobsBehavioral Health Utilization Management JobsBehavioral Health Utilization Management Jobs in Massachusetts

Behavioral Health Utilization Management information

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$23

$46

$75

How much do behavioral health utilization management jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for behavioral health utilization management in Massachusetts is $46.18, according to ZipRecruiter salary data. Most workers in this role earn between $36.49 and $53.03 per hour, depending on experience, location, and employer.

What is behavioral health utilization management?

Behavioral Health Utilization Management is a process used by insurance companies and healthcare organizations to evaluate the necessity, appropriateness, and efficiency of behavioral health services such as mental health and substance use treatments. This process helps ensure that patients receive the right level of care based on clinical guidelines while managing healthcare costs. Utilization managers review treatment plans, authorize services, and coordinate with providers to promote quality outcomes and avoid unnecessary services. Their work is essential in balancing patient needs with resource allocation in the healthcare system.

What skills and qualifications are needed for behavioral health utilization management?

To thrive as a Behavioral Health Utilization Management professional, you need a background in behavioral health or clinical care, often with an RN, LCSW, LPC, or similar licensure and experience in mental health care settings. Familiarity with utilization review software, insurance guidelines, and electronic health record (EHR) systems is crucial. Strong analytical thinking, communication, and negotiation skills are essential soft skills to effectively evaluate treatment plans and coordinate with providers. These competencies are vital to ensuring appropriate, cost-effective care while maintaining compliance with regulatory and payer requirements.

What are common challenges in behavioral health utilization management and how are they addressed?

Behavioral Health Utilization Management professionals often encounter challenges such as managing high caseloads, keeping up with evolving clinical guidelines, and ensuring timely communication with providers and insurance companies. Balancing the need for cost containment with advocating for appropriate patient care can also be demanding. These challenges are typically addressed through ongoing training, strong teamwork, and the use of evidence-based criteria and decision-support tools to guide determinations and streamline workflows.

What is the difference between Behavioral Health Utilization Management vs Behavioral Health Case Manager?

AspectBehavioral Health Utilization ManagementBehavioral Health Case Manager
CredentialsLicenses (e.g., RN, LCSW), certifications in utilization reviewLicenses (e.g., LCSW, LPC), case management certifications
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community clinics, outpatient facilities
Employer & Industry UsageHealth insurance providers, managed care organizationsBehavioral health agencies, hospitals, outpatient clinics

Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.

What are popular job titles related to Behavioral Health Utilization Management jobs in Massachusetts?

For Behavioral Health Utilization Management jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Management jobs in Massachusetts look for?

The top searched job categories for Behavioral Health Utilization Management jobs in Massachusetts are:

Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 19% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $96,048 per year, or $46.2 per hour.

Patient Care Technicians - Behavioral Health Tech

Well Sense Health Plan

Charlestown, MA • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Behavioral Health Utilization Manager

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. The position is responsible for managing complex outpatient and non-24-hour diversionary cases. The role requires a proactive and analytical approach to service delivery, with a focus on clinical quality and compliance.

Responsibilities include using advanced clinical judgment to evaluate outpatient and non-24-hour behavioral health services. The manager determines the appropriateness of care based on individual member needs, clinical presentations, and professional standards. Collaboration with Medical Directors is required when clinical complexity necessitates further review. Identification of members who may benefit from enhanced care coordination or specialized interventions is essential. The manager must ensure accurate, timely documentation of clinical decisions per operational standards. Clear communication with internal and external stakeholders is vital to resolve questions or concerns. Participation in clinical rounds and interdisciplinary case discussions supports collaborative care planning and cross-functional learning. The role entails representing the organization with external partners and ensuring compliance with regulations. Monitoring clinical trends for potential indicators of Fraud, Waste, and Abuse is a key responsibility. Partnership with leadership will be necessary to evaluate existing processes and support initiatives aimed at improving quality. Crisis intervention support using clinical judgment to de-escalate situations is a required function of the role. The manager must uphold all organizational policies, professional standards, and compliance requirements. Opportunities to contribute to special projects and initiatives will arise as assigned by senior leadership. Providing Network Management in collaboration with other organizations may require some travel within designated areas.

Must-Have: Master's degree in Social Work, Psychology, Counseling, or a related Behavioral Health field. Expertise in utilization management and medical necessity determinations. Experience with Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services is preferred. Proficiency in Microsoft Office applications, particularly Outlook, Word, and Excel.

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