Massachusetts Licensed Behavioral Health Reviewer

Job Summary

A company is looking for a Clinical Reviewer for Behavioral Health outpatient services.

Key Responsibilities

• Conduct benefit coverage reviews and utilization management according to regulatory guidelines
• Collaborate with Behavioral Health leadership to improve service and reduce administrative costs
• Review prior authorization requests and ensure compliance with organizational standards

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 practice clinical experience in the area of credential and knowledge of utilization management principles
• Health Plan experience performing utilization review activities
• Experience with McKesson's InterQual Clinical Screening Criteria preferred