Utilization Review Clinician

TaraVista Behavioral Health Center; Harvard (MA); On-site; USD 82,000 - 91,000; Full time

Benefits offered by this job

Medical, Dental, and Vision

401(k) match

Employer paid LTD

STD

Employer paid life and AD&D Insurance

Generous Paid Time Off

Flexible Spending Account

Tuition Reimbursement

Job summary

The Vista's in Devens, MA is seeking a Utilization Review Clinician to join a multidisciplinary health care team. You will handle pre-certification, concurrent and discharge reviews and appeals, ensuring compliance with payer requirements and CMS measures while integrating clinical and financial information.

Requirements include a Master's level clinician or RN, plus experience in utilization management in inpatient psychiatry; licensure eligible (LMHC/LICSW or RN); strong communication and

Qualifications

• Master's level clinician or RN required.
• Previous utilization management experience, preferably in inpatient psychiatric setting.
• License eligible (LMHC or LICSW preferred) or RN.
• Knowledge of clinical treatment of psychiatric patients and managed care environment.
• Strong communication skills and ability to integrate clinical and financial information in utilization management.
• Ability to work in a multidisciplinary, fast-paced environment with autonomy and professionalism.

Responsibilities

• Participate actively in the health care team.
• Handle pre-certification, concurrent and discharge reviews, appeals and denials.
• Ensure compliance with contracted quality measures identified by managed care organizations and CMS.
• Serve as liaison between the hospital and outside payor sources.

Skills

Utilization management

Inpatient psychiatry

RN license

LMHC

LICSW

Communication

Autonomy

Education

Master's degree

RN license

Job description

Schedule: Full time, 40 hours/week. On-site in Devens, MA.

As a Utilization Review Clinician for The Vista's, you’ll bring your experience and knowledge where your voice matters. A Utilization Review Clinician is an integral part of our multidisciplinary team.

• You will be an active participant in the health care team.
• You will be responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations and CMS.
• You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of The Vista's.

The Utilization Review Clinician will have the following:

• Master's level clinician or RN.
• Previous utilization management experience, preferably in an inpatient psychiatric setting.
• License eligible (LMHC or LICSW preferred) or RN.
• Possess sufficient knowledge regarding clinical treatment of psychiatric patients, the mental health care delivery system, and the managed care environment.
• Display excellent communication skills and an ability to integrate clinical and financial information in the context of an overall utilization management program.
• Requires the ability to work in a multidisciplinary, fast paced environment with a demonstrated sense of autonomy and professionalism.

When you join the growing Vista's team as a Utilization Review Clinician, you’ll receive:

• Medical, Dental, and Vision
• 401(k) match
• Employer paid long term disability (LTD)
• Short term disability (STD)
• Employer paid life and AD&D Insurance
• Generous Paid Time Off
• Flexible Spending Account
• Tuition Reimbursement

Pay Range:

Compensation will be determined based on the candidate's relevant experience.

$82,000 - $91,000

The Vista's is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.