Massachusetts Licensed Behavioral Health Reviewer

Job Summary

A company is looking for a Clinical Reviewer in Behavioral Health.

Key Responsibilities

• Conduct benefit coverage reviews and utilization management in accordance with regulatory guidelines
• Collaborate with Behavioral Health leadership to improve service delivery and reduce costs
• Review prior authorization requests and determine medical necessity for behavioral health services

Required Qualifications

• Current unrestricted Massachusetts license in a behavioral health area of practice
• Minimum education: BS Nursing; LICSW, LMHC, or equivalent behavioral health qualification
• Direct clinical experience in utilization management and health plan activities
• Experience with McKesson's InterQual Clinical Screening Criteria preferred
• Minimum of 3 years in a managed care environment preferred