Remote Behavioral Health Utilization Clinician

P32HS Point32Health Services Inc; Canton (MA); Hybrid; USD 80,000 - 121,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health in Massachusetts seeks a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and clinical determinations under supervision within the Behavioral Health department.

The role partners with UM leadership and staff to improve service, control costs, and ensure clinically appropriate care while maintaining regulatory compliance. Remote work as required with a fast-paced environment.

Qualifications

• Current unrestricted Massachusetts license in a behavioral health area of practice.
• BS Nursing degree is required or LICSW/LMHC or other behavioral health independent practice qualification.
• Direct practice clinical experience in credentialed area.
• Knowledge of utilization management and care management principles.

Responsibilities

• Adhere to behavioral and administrative review guidelines and criteria.
• Meet timelines and notification requirements.
• Interact with UM Support staff and providers to ensure clinical information is available.
• Prioritize authorization requests.
• Achieve productivity goals.
• Review prior authorization requests including inpatient, referrals, outpatient procedures; use clinical criteria.
• Conduct concurrent review of Behavioral Health Services.
• Determine benefit coverage for behavioral health requests.
• Identify medical necessity of out-of-network requests.
• Communicate with Medical Director about variances.
• Engage in professional development and collaborate with case management.

Skills

Teamwork

Results oriented

Critical thinking

Adaptability

Influence

Communication

Confidentiality

Tech literacy

MS Office (Word/Excel)

Education

BS Nursing

LICSW/LMHC or equivalent

Tools

InterQual Criteria

Job description

Point32Health in Massachusetts seeks a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and clinical determinations under supervision within the Behavioral Health department.

The role partners with UM leadership and staff to improve service, control costs, and ensure clinically appropriate care while maintaining regulatory compliance. Remote work as required with a fast-paced environment.