Utilization Reviewer

South Bay Community Services - Worcester, MA3.0

30+ days agoFull-time

Do you want to work with leaders in your field to make an impact in underserved communities? Come join South Bay Community Services, a leader in community-based behavioral health care. At South Bay, our mission is to encourage the self-sufficiency of disadvantaged people through behavioral health care services that are grounded in the community. We provide adult, child, and family counseling for a broad range of issues, including: mental health/illness, substance abuse recovery, intensive family matters, trauma, and forensics.

Role of Utilization Reviewer

Primarily responsible for overseeing the Utilization Review process for the Day Services Program.

Duties & Responsibilities of Utilization Reviewer

  • Oversee all utilization review for MCOs and private insurances for entire Day Services division.
  • Ensure all insurance providers are satisfied with the quality of care to Day Services consumers.
  • Collaborate with directors and clinical staff to ensure medical necessity is appropriately documented.
  • Review non-billable report monthly with the Regional Billing Coordinator to ensure information is accurate.
  • Conduct clinical trainings as needed for entire agency.
  • Conduct licensed supervision for the entire agency as needed.
  • Attend management meetings as necessary.
  • Other duties as required.

Experience & Skills of Utilization Reviewer

  • One year experience within a Day treatment program.

Educational & Licensing Requirements

  • Master's degree in Psychology, Social Work, or related human services field required.
  • Must hold a license (LMHC, LICSW, LFMT, LADC1, LCSW) granted by the State of Massachusetts.

Benefits of Working at South Bay:

  • We are passionate and dedicated to helping our community
  • You get hands-on, invaluable experience working with our consumers in their environment
  • As a South Bay employee, you have a clear growth potential/ career path.
  • We continually offer training and have a successful on-boarding process.
  • We offer competitive salary, mileage stipend, health benefits, paid time off, flexible schedule for clinical staff, strong team environment, in service training, electronic health records, professional liability insurance, and career advancement.

South Bay Community Services is an Affirmative Action/Equal Opportunity Employer

Job Code: 2150

Job Type: Full-time


  • Master's (Required)


  • LMHC, LICSW, LFMT, LADC1, LCSW granted by the State of Mass (Required)

Nursing Clinical Setting:

  • Home Care


  • Home Health