Remote Behavioral Health Utilization Review Jobs in Springfield, MA

Opportunity: Behav Health Clinician Rev

Salary Range: $75,000-$90,000

Division: PLADS

Recruiter: Jalisa Jakes

Job Posting End Date: August 31, 2026

We've Got You Under Our Wing

We are the duck. We develop and empower our people, cultivate relationships, give back to our community, and celebrate every success along the way. We do it all...The Aflac Way.

Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands. Aflac has been recognized as Fortune's 50 Best Workplaces for Diversity and as one of World's Most Ethical Companies by Ethisphere.com.

Our business is about being there for people in need. So, ask yourself, are you the duck? If so, there's a home, and a flourishing career for you at Aflac.

Worker Designation - This role is a remote role. This means you will be expected to work from your home, within the continental US. If the role is remote, there may be occasions that you are requested to come to the office based on business need. Any requests to come to the office would be communicated with you in advance.

What does it take to be successful at Aflac?

• Acting with Integrity
• Communicating Effectively
• Pursuing Self-Development
• Serving Customers
• Supporting Change
• Supporting Organizational Goals
• Working with Diverse Populations

What does it take to be successful in this role?

•  Psychiatric experience/knowledge
•  Solid investigative and analytical skills
•  Solid customer service skills
•  Solid written and oral communication skills
•  Solid organizational and time management skills
•  Ability to analyze behavioral health records in the context of functional capacity
•  Maintain active licensing and profession credentials as required
•  Model behaviors that demonstrate commitment to corporate values
•  Educate team members and business partners on area of clinical expertise
•  Provide guidance and support for team members

Education & Experience Required

• Bachelor's Degree In healthcare or a related field, e.g. nursing
• Master's Degree In Behavioral Health area or related field, e.g., MSW, MA or MS in counseling

• A minimum of 3 years of experience in the field of behavioral health working with behavioral health patients.
• Active clinical license e.g., LCSW, LMHC, LPC, RN etc. or equivalent clinical license.

Or an equivalent combination of education and experience

Education & Experience Preferred

• 2 or more years of experience in disability management industry managing claims.
• CDMS or CCM designations.
• Utilization review experience and/or experience using specific behavioral health criteria or protocols.

Travel

10%

Principal Duties & Responsibilities

• Serves as clinical co-manager on behavioral health claims from inception of STD claims, and provides activities requiring clinical expertise including, but not limited to performing provider interviews, analyzing clinical information submitted, and negotiating return to work plans with employees, treating provider, and employer if applicable.
• Reviews and evaluates disability claim to determine level of functioning based on knowledge of behavioral health conditions, knowledge of the employer and the employee's job requirements and the plan's definition of disability.
• Investigates and resolves inconsistencies in the level of cognitive, emotional, or behavioral functioning.
• Coordinates a strategy to determine true level of functional capacity, utilizing direct contact with the treating provider and/or utilizing internal clinical resources (e.g., Peer-to-Peer Reviews, internal impairment guides, round table reviews, etc.).
• Reviews claims from a behavioral health perspective to determine if clinical evidence supports preclusion from work, or the need for accommodation and/or restrictions, based on vocational demands per the applicable definition of disability.
• Documents impairment, functional status, and assessment, to include behavioral health, contractual, and vocational information.
• Acts as behavioral health consultant to the appeals business unit.
• Acts as resource for claims and clinical staff when handling claimants noted to be threatening harm to themselves or others.
• Facilitates referrals to collateral internal and external services, e.g., EAP, disease management programs, Advocacy, etc. as applicable.
• Monitors response to care and advocates for optimal care when applicable.
• Coordinates and monitors quality of behavioral health IME's.
• Coordinates internal physician consultant referrals, by using supporting clinical resources and vocational resources.
• Identifies barriers for employees to return-to-work; identifies appropriate (optimal) health care, rehabilitation, and work to facilitate an appropriate and timely return-to-work.
• Communicates effectively with case managers, employers, employees, and health care providers.
• Strategizes with claimant, treating providers, and employer on possible accommodations or restriction utilization to facilitate return-to-work.
• Manages daily relations with assigned accounts and key contacts.
• Per account requirements and upper management request, visits clients for new account implementation and maintenance of existing accounts.
• Attends and/or presents clinical lectures designed to educate claim staff as requested.
•  Anticipates, recognizes, and responds timely to needs of customers to ensure customer satisfaction.
• Supports implementation of customer initiatives to drive best outcomes.
• Reviews assigned customer cases, prioritizes workload, and interprets established policies, applying discretion within authority limits to resolve customer issues.
• Provides status updates on co-management plans, to ensure clear communications and transparency.
• Resolves technical problems by referring to policies, procedures, and specifications, to ensure accuracy and operational consistency.
• Collects data and prepares clinical reviews, including commentary and an analysis to facilitate decision-making.
• Provides detailed procedural advice to internal clients, to ensure internal standards and/or procedures are adhered to related to clinical co-management.
• Inputs relevant data into established systems accurately to allow for data analysis.
• Performs additional job duties as needed.

Total Rewards

The salary range for this job is $75,000 to $90,000.This range is specific to the job and salary offers consider a wide range of factors that are considered in making compensation decisions, including, but not limited to: education, experience, licensure, certifications, geographic location, and peer compensation. The range has been created in good faith based on information known to Aflac at the time of the posting.

At Aflac, it is not typical for an individual to be hired at or near the top of the range for the role to allow for future and continued salary growth, and compensation decisions are dependent on the circumstances of each case. This salary range does not include any potential incentive pay or benefits, however, such information will be provided separately when appropriate.

In addition to the base salary, we offer an array of benefits to meet your needs including medical, dental, and vision coverage, prescription drug coverage, health care flexible spending, dependent care flexible spending, Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee), 401(k) plans, annual bonuses, and an opportunity to purchase company stock.  On an annual basis, you'll also be offered 11 paid holidays, up to 20 days PTO to be used for any reason, and, if eligible, state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked) and other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being. Aflac complies with all applicable leave laws, including, but not limited to, sick and safe leave, and adoption and parental leave, in all states and localities.