Massachusetts Licensed Clinical Reviewer

A company is looking for a Utilization Management (UM) Clinical Care Reviewer II - Behavioral Health. Key Responsibilities Process medical necessity reviews for behavioral health services and assist with discharge planning activities Coordinate care with collaborative partners and engage with medical directors for additional clinical expertise Maintain knowledge of regulations and identify quality issues for referral to Quality Improvement and Care Management Required Qualifications, Training, and Education Associates of Science (A.S) in Nursing or Bachelor of Science (B.S) in Social Work required Three (3) years of clinical experience required Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required

Created: 2026-03-05