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Baystate HealthPosted 10/20/2026full-timeSpringfield • Massachusetts • United StatesMid-LevelSenior💰 $89,606 - $121,804 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical necessity utilization management and care coordination for behavioral health, with a strong foundation in clinical assessment, regulatory compliance, and interdisciplinary collaboration.
Highest-signal resume keywords
Master’s Degree In Social Work (MSW)Current Licensure In Massachusetts (LICSW, LCSW, LMHC, Licensed Psychologist, RN)Three To Five Years Of Behavioral Health Clinical ExperienceWorking Knowledge Of DSM-5 Diagnostic CriteriaExperience Utilizing Electronic Utilization Management Systems
About the role
Key responsibilities & impact- Perform medical necessity utilization management and care coordination activities for evidence-based behavioral health care
- Review behavioral health services using nationally recognized clinical criteria
- Conduct pre-authorization, admission, concurrent, retrospective, and discharge reviews for inpatient and outpatient services
- Evaluate requested levels of care and treatment plans
- Collaborate with physician reviewers on medical necessity determinations and denials
- Research and obtain clinical information supporting utilization management decisions
- Assess requests for out-of-network services
- Support discharge planning and transitions across the continuum of care
- Coordinate behavioral health services and transitions with providers and interdisciplinary teams
- Facilitate referrals to community-based services and internal care management programs
- Assist with provider and member appeals
- Participate in quality improvement initiatives, clinical projects, and departmental workgroups
- Contribute to departmental policies and procedures
- Participate in off-site visits with contracted behavioral health providers and facilities as needed
- Maintain documentation supporting clinical decisions
- Ensure compliance with NCQA, DOI, regulatory timelines, and quality standards
- Complete onboarding and training at 1 Monarch Place in Springfield, Massachusetts before transitioning to fully remote work
Requirements
What you’ll need- Master’s degree in social work (MSW) or equivalent behavioral health clinical education
- Current licensure in Massachusetts as LICSW, LCSW, LMHC, Licensed Psychologist, or Registered Nurse (RN) with behavioral health experience
- Three to five years of behavioral health clinical experience, including inpatient behavioral health, outpatient or ambulatory behavioral health, case management, emergency psychiatric services, or diversionary levels of care
- Working knowledge of DSM-5 diagnostic criteria
- Familiarity with ASAM Criteria and behavioral health medical necessity guidelines
- Understanding of psychotropic medications and behavioral health treatment modalities
- Knowledge of regional behavioral health resources and community services
- Strong clinical assessment and critical thinking skills
- Excellent written and verbal communication skills
- Ability to prioritize multiple cases while meeting regulatory timelines
- Experience utilizing electronic utilization management or care management systems
- Commitment to maintaining confidentiality and handling sensitive behavioral health information professionally
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Necessity Utilization ManagementBehavioral Health Clinical AssessmentPre-Authorization ReviewsConcurrent ReviewsDischarge PlanningCritical Thinking SkillsKnowledge Of Psychotropic MedicationsUnderstanding Of ASAM CriteriaBehavioral Health Treatment ModalitiesDocumentation Of Clinical Decisions
Soft Skills
Excellent Written Communication SkillsExcellent Verbal Communication SkillsAbility To Prioritize Multiple CasesCommitment To ConfidentialityCollaboration With Interdisciplinary Teams
Tools & Technologies
Electronic Utilization Management SystemsCare Management Systems
Certifications & Qualifications
Current Licensure In Massachusetts
Industry Keywords
Behavioral Health CareClinical CriteriaQuality Improvement InitiativesNCQA ComplianceRegulatory Timelines