HNE Behavioral Health Utilization Management Reviewer

At Health New England, we're committed to ensuring our members receive timely, appropriate, and compassionate behavioral health services. As a Behavioral Health Utilization Management Reviewer , you'll play a vital role in ensuring our members are in the appropriate behavioral health level of care while helping providers understand the available resources across the continuum of care. In this collaborative role, you'll partner with providers, physicians, care managers, and community resources to review medical necessity, coordinate care, and support positive clinical, functional, and psychosocial outcomes for our members. If you're a licensed behavioral health professional who thrives in a fast-paced environment and is passionate about improving the lives of individuals facing mental health and substance use challenges, we'd love to hear from you. Responsibilities As a Behavioral Health Utilization Management Reviewer, you will perform medical necessity utilization management and care coordination activities that promote quality, cost-effective, evidence-based behavioral health care. Utilization Management Review behavioral health services for medical necessity using nationally recognized clinical criteria. Conduct pre-authorization, admission, concurrent, retrospective, and discharge reviews for inpatient and outpatient behavioral health services. Evaluate the appropriateness of requested levels of care and treatment plans. Collaborate with physician reviewers on cases requi