Clinical Reviewer (Inpatient), Behavioral Health
$76k/y-$114k/y
Point32Health13 days ago
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OnsiteFull-timeMid
Summary
Point32Health is seeking a Clinical Reviewer (Inpatient), Behavioral Health to join their team in Massachusetts. The role involves conducting benefit coverage reviews and utilization management for behavioral health services.
About the Role
As a Clinical Reviewer (Inpatient), Behavioral Health, you will be responsible for adhering to established behavioral and administrative review guidelines, conducting daily interactions with UM Support staff and providers, prioritizing authorization requests, and reviewing prior authorization requests for inpatient admissions and outpatient procedures. You will also identify medical necessity for out-of-network requests and communicate effectively with the Medical Director regarding variances.
About You
Required:
- 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 with knowledge of utilization management and care management principles.
- Health Plan experience performing utilization review activities.
- Experience with McKesson’s InterQual Clinical Screening Criteria.
Preferred:
- 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
Point32Health
Guiding and empowering healthier lives for everyone.
Massachusetts, United States