Description

Licensed Clinical Social Worker (LCSW)
Location: Charlestown, MA
Agency: Cynet Health
Pay: $1,845 per week
Shift Information: Days - 5 days x 8 hours
Contract Duration: 14 Weeks
Start Date: 8/17/2026

About the Position

Job Title: Behavioral Health Utilization Manager Profession: Behavioral Health Specialty: 24 Hour Diversionary Services Duration: 14 Shift: 8hrs Hours per Shift: 40 Experience: 5-7 years in a health insurance environment with a focus on behavioral health License: Active, unrestricted independent licensure Certifications: LICSW, LMHC, or LMFT preferred Must-Have: Expertise in utilization management and medical necessity determinations Description: The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and substance use disorder services. This role serves as a key clinical decision-maker, exercising independent judgment and critical thinking in the evaluation of behavioral health service requests. This position is responsible for managing complex outpatient and non-24-hour diversionary cases, applying clinical expertise to ensure appropriate, timely, and effective care. The role requires a proactive and analytical approach to service delivery, with a focus on clinical quality and compliance. Use advanced clinical judgment and critical thinking to evaluate outpatient and non-24-hour behavioral health services. Determine the appropriateness of care based on individual member needs, clinical presentations, and professional standards. Collaborate with Medical Directors when clinical complexity requires further review, ensuring decisions align with clinical best practices and organizational values. Identify members who may benefit from enhanced care coordination or specialized interventions and initiate appropriate referrals to internal programs. Ensure accurate, timely, and well-reasoned documentation of clinical decisions in accordance with operational standards and regulatory expectations. Provide clear, thoughtful communication to internal and external stakeholders, helping resolve questions or concerns with clinical insight in a timely manner. Participate in clinical rounds and interdisciplinary case discussions to support collaborative care planning and cross-functional learning. Represent the organization with external partners, conveying clinical insight and ensuring organizational compliance. Monitor clinical trends for potential indicators of Fraud, Waste, and Abuse (FWA), and take appropriate action when concerns are identified. Partner with leadership and the Medical Director to evaluate existing processes and support initiatives aimed at improving quality and operational efficiency. Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions. Uphold all organizational policies, professional standards, and compliance requirements. Contribute to special projects and organizational initiatives as assigned by senior leadership, offering insight and subject matter expertise. Demonstrated expertise in Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services is preferred. Familiarity with managed care principles and regulatory compliance requirements is also beneficial. Superior analytical and problem-solving skills along with a keen attention to detail are essential for success in this role. The work environment is primarily remote with some travel for meetings and training sessions required. Candidates should possess exceptional verbal and written communication skills. Strong organizational and time management abilities are necessary to balance multiple responsibilities while maintaining accuracy and efficiency.

Requirements

Required for Onboarding

• BLS
• Pharmacology
• Skills Checklist
• Specialty Exam