Massachusetts Licensed Clinical Reviewer

Job Summary

To support behavioral health services, the full-time Massachusetts Licensed Clinical Reviewer will process medical necessity reviews, assist with discharge planning, and coordinate care for members in a remote work environment.

Key responsibilities:

• Complete prospective, concurrent, and retrospective reviews of Behavioral Health services
• Engage with collaborative care partners to facilitate transitions to appropriate levels of care
• Maintain knowledge of state and federal regulations, and refer quality issues to Quality Improvement

Required qualifications:

• Current, unrestricted licensure as a Registered Nurse or a licensed social worker (LSW, LCSW, LICSW, etc.) required
• Associate's degree in Nursing, Bachelor's degree in Social Work, or Master's degree in a mental health-related field required
• Three years of clinical experience required
• Utilization Management/Utilization Review experience preferred
• MCG Certification required or must be obtained within six months of hire