Massachusetts Licensed Clinical Reviewer

Job Summary

Responsible for processing medical necessity reviews for behavioral health care services, the full-time Massachusetts Licensed Clinical Reviewer will work remotely to assist with discharge planning and care coordination for members.

Key responsibilities:

• Complete prospective, concurrent, and retrospective reviews of Behavioral Health services
• Identify and coordinate care with collaborative partners to facilitate transitions to appropriate levels of care
• Provide guidance and support to non-clinical and LPN staff while engaging with medical directors for additional clinical expertise

Required qualifications:

• Current, unrestricted Registered Nurse (RN) Licensure or equivalent mental health licensure required
• Associates of Science (A.S) in Nursing, Bachelor of Science (B.S) in Social Work, or a Master's degree in a mental health-related field required
• Three (3) years of clinical experience required
• MCG Certification is required or must be obtained within six (6) months of hire
• Utilization Management/Utilization Review experience preferred