Behavioral Health Utilization Management Supervisor - Enhanced UM and ED Boarding

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

The Behavioral Health Utilization Management (BH UM) Supervisor is responsible for providing administrative and clinical oversight to a team of BH UM clinicians, ensuring compliance with regulatory and organizational standards. The supervisor will lead training efforts, monitor caseloads, and serve as the primary contact for state agency interactions. The ideal candidate must have significant experience supervising master’s level clinicians, along with extensive experience in behavioral health services and utilization management within a health insurance setting. Our Investment in You: Full-time remote work Competitive salaries Excellent benefits

Provide comprehensive training, administrative support, and clinical supervision to BH UM clinicians to ensure adherence to best practices and regulatory requirements. Serve as the primary liaison for state agency outreach and meetings, addressing member needs and representing the organization in stakeholder discussions. Monitor and manage Emergency Department (ED) boarding cases, ensuring timely interventions and appropriate care planning. Oversee Utilization management reporting and track caseloads to identify trends and opportunities for process improvement. Conduct regular audits of clinical files to verify compliance with contractual obligations, accreditation standards (e.g., NCQA), and internal policies. Act as the initial point of contact for escalated member cases, working closely with internal teams and external stakeholders to facilitate timely resolutions. Provide coverage support across all BH UM teams to maintain continuity of operations during peak times or staff absences. Participate in weekly meetings with state agencies, care management teams, and other key stakeholders to align efforts and share updates. Support the development and implementation of policies and procedures to enhance the effectiveness of the utilization management process. Collaborate with IT and data analytics teams to enhance reporting capabilities and track key performance indicators. Lead quality improvement initiatives aimed at optimizing care outcomes and enhancing the member experience. Ensure accurate and timely documentation of all activities in accordance with department policies and compliance guidelines. Promote a culture of continuous learning and professional development among BH UM clinicians. Contribute to special projects and organizational initiatives as assigned by senior leadership, offering insight and subject matter expertise Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions. In rotation with other behavioral health leadership, provide back-up support to the on-call UM clinician