Massachusetts Licensed Clinical Reviewer

Job Summary

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

Key Responsibilities

• Conduct benefit coverage reviews and utilization management according to regulatory guidelines
• Collaborate with Behavioral Health leadership to improve service and ensure clinically appropriate delivery of services
• Identify and determine medical necessity for behavioral health coverage requests and escalate urgent issues as needed

Required Qualifications

• Current unrestricted Massachusetts license in a behavioral health area of practice
• Minimum education: BS Nursing; LICSW, LMHC, or equivalent behavioral health profession
• Direct practice clinical experience in utilization management and care management principles
• Health Plan experience performing utilization review activities
• Experience with McKesson's InterQual Clinical Screening Criteria preferred