Utilization Management Reviewer - Behavioral Health

Location: Hingham, Massachusetts, United States

Hourly range: $38.82–$47.44, plus variable pay.

Company

hirify.global is a healthcare organization focused on facilitating medically appropriate, high-quality care for members.

What you will do

• Conduct pre-certification, concurrent, and retrospective clinical reviews for inpatient, acute residential treatment, and partial hospitalization cases.
• Apply evidence-based medical necessity criteria, InterQual behavioral health criteria, and company policies to determine appropriate levels of care.
• Manage utilization efficiently, with emphasis on discharge planning and member benefit optimization.
• Collaborate with physician reviewers, case managers, project leaders, providers, members, families, and treatment teams.
• Coordinate provider health action plans, including treatment goals, interventions, and expected clinical outcomes.
• Educate members and families about benefits, eligibility, policies, and utilization management processes.

Requirements

• Behavioral health professional with an active Massachusetts license as a Registered Nurse, LICSW, LMHC, or BCBA.
• 3–5 years of clinical experience in behavioral healthcare settings.
• Solid clinical knowledge of behavioral health and the ability to manage multiple ongoing tasks under time-sensitive deadlines.
• Strong communication, problem-solving, organization, teamwork, independent-work, and customer-service skills.
• Intermediate proficiency with Microsoft Word, Excel, Outlook, and common computer systems.
• Ability to achieve a passing score on the annual InterQual behavioral health medical necessity criteria inter-rater reliability test.

Nice to have

• Utilization management experience.
• CCM or another applicable professional certification.
• Specialty behavioral health knowledge.

Culture & Benefits

• Collaborative work with medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors.
• Paid time off and medical, dental, and vision insurance.
• 401(k) and additional well-being benefits for eligible employees.
• Professional development resources and opportunities to build an individual career path.
• Focus on wellness, inclusion, and work-life balance.