Utilization Review Clinician

MiraVista Behavioral Health Center; Holyoke (MA); On-site; USD 80,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental/Vision

401(k) match

Disability insurance

Life/AD&D

Paid time off

Flexible Spending Account

Tuition reimbursement

Job summary

As a Utilization Review Clinician at The Vista's Behavioral Health Center in Holyoke, MA, you’ll bring your experience and knowledge where your voice matters. You’ll be an integral part of our multidisciplinary team.

You will handle pre-certification, concurrent and discharge reviews, appeals and denials, and ensure compliance with contracted quality measures identified by managed care organizations. You will also serve as a liaison between the hospital and outside payors.

Qualifications

• Master's level clinician or RN with relevant licensure.
• Experience in utilization management, preferably in inpatient psychiatry.
• Eligible for licensure (LMHC/LICSW) or RN.
• Strong communication and ability to integrate clinical and financial data.

Responsibilities

• Participate as a member of the multidisciplinary health care team.
• Handle pre-certification, concurrent and discharge reviews, appeals and denials, and quality measure compliance.
• Liaise between hospital and outside payor sources per mission and core principles.

Skills

Master's or RN

Utilization management

Psychiatric inpatient exp

Clinical communication

Autonomy in fast-paced env

Education

Licensure eligible (LMHC/LICSW) or RN

Job description

Schedule: Onsite Monday-Friday, 40 hours/week Holyoke, MA.

As a Utilization Review Clinician for The Vista's in Holyoke, MA, 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 are responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations.
• You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of The Vista's Behavioral Health Center.

The Utilization Review Clinician will have the following:

• Master's level clinician or RN.
• Previous utilization management, 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 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.

$80,000 - $90,000

The Vista's are 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.