Guiding and empowering healthier lives for everyone.

Clinical Reviewer, Behavioral Health

Medical ReviewerMedical ReviewerFull TimeRemoteTeam 1,001-5,000H1B No SponsorCompany Site LinkedIn

Location

Massachusetts

Posted

44 days ago

Salary

$76.1K - $114.2K / year

Bachelor Degree3 yrs expEnglish

Job Description

• Conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise contract requirements • Daily interactions with UM Support staff and providers to ensure clinical information and support are available and applicable to the review process • Appropriate prioritization of authorization requests • Review of all assigned prior authorization requests including but not limited to inpatient admissions, specialty referrals, outpatient procedures, VNA or outpatient therapies • Concurrent review of Behavior Health Services

Job Requirements

Current unrestricted Massachusetts license in a behavioral health area of practice
BS Nursing; LICSW, LMHC, or other behavioral health profession qualified to practice independently
Direct practice clinical experience in area of credential
Must demonstrate sound knowledge of utilization management and care management principles
Health Plan experience performing utilization review activities
Experience with McKesson’s InterQual Clinical Screening Criteria
3 years in a managed care environment in managed care systems and operations.

Benefits

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health

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