Massachusetts Licensed Behavioral Health Reviewer

Job Summary

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

Key Responsibilities

• Conduct benefit coverage reviews and utilization management according to regulatory guidelines
• Collaborate with Behavioral Health leadership and staff to improve service 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 of a BS in Nursing or equivalent behavioral health qualification
• Direct clinical experience in utilization management and care management principles
• Experience with McKesson's InterQual Clinical Screening Criteria
• Preferred experience of 3 years in a managed care environment