Utilization Review Manager - Home Care jobs in Massachusetts

We make a difference - in your community and your career

Relief Clinician - Utilization Review (CBHC)

*Independent Licensure - LMHC or LICSW Required*

The Clinician – Utilization Review provides Utilization Review services for the CBHC component. This position plays a crucial role in ensuring the quality and efficiency of behavioral health services provided to our clients by conducting comprehensive Utilization Reviews as part of a multi-disciplinary team.

Job Responsibilities:

• Perform thorough reviews of clinical documentation and treatment plans to determine the appropriateness, necessity, and quality of behavioral health services rendered to clients.

• Ensure Golden Thread throughout electronic health record chart.

• Review chart for completion of all administrative documents such as intake paperwork, current Release of Information, etc.

• Collaborate with clinical staff, providers, and insurance companies to optimize the utilization of CBHC resources while maintaining high standards of care and compliance with regulatory requirements.

• Provide recommendations for level of care, treatment modality, treatment goals, etc.

• Clinical Documentation Review: Review and analyze client records, progress notes, treatment summaries, and other relevant documentation to ensure accuracy, completeness, and compliance with organizational policies and external regulations.

• Provide training, guidance, and support to clinical staff on utilization review processes, documentation requirements, and best practices to promote adherence to organizational standards and regulatory guidelines.

Schedule: Relief

Payrate: $34.91/hourly

Why You'll Love Riverside
We make a true difference in people’s lives through rewarding work. Most of our jobs come with great benefits – including healthcare, numerous professional development opportunities, and generous time off - all in a respectful and inclusive environment, perhaps why Riverside was named a Boston Globe Top Workplace and a best-in-state employer by Forbes.

Benefits include:

• Comprehensive, high-quality health, dental, and vision insurance options
• Flexible Spending Accounts – both medical and dependent care
• Eleven paid holidays
• Separate accruals for vacation (increases with tenure), personal, and sick time
• Tax-deferred 403(b) retirement savings plan with employer match
• Employee Assistance Plan / Travel Assistance Plan
• Employee bonus for referrals resulting in hiring
• Discounts to movie theaters, sporting, and entertainment events
• Employee YMCA discount: 10% off a YMCA monthly membership and 50% off the joiner’s fee

Learn more about our benefits and culture:

Our Benefits

Our Culture

Hear what employees think about working for Riverside!

• Strong understanding of utilization management principles, medical necessity criteria, and regulatory requirements governing behavioral health services is required

• Must have excellent analytical skills, with the ability to review and interpret complex clinical documentation and utilization data accurately.

• Effective communication and interpersonal skills, with the ability to collaborate with multidisciplinary teams, providers, and external stakeholders is required

• Proficiency in utilizing electronic health record systems and Microsoft Office Suite required

• Master’s degree in counseling, Social Work, Psychology, or related field required

• Current licensure as an independently licensed clinician (LMHC or LICSW) in the state of Massachusetts required

• Minimum of 2 years of clinical experience in behavioral health settings, with expertise in conducting assessments, treatment planning, and delivering evidence-based interventions, is required

Riverside Community Care is dedicated to respect, integrity and engagement of all individuals. We are committed to building an inclusive and culturally competent organization and we value the richness of having a diverse applicant pool. As an employer committed to equal opportunity, all qualified applicants will receive consideration for employment without regard to race, age, color, religion, gender, marital status, sexual orientation, military status, national origin, disability, or any other characteristic as established by law.