Utilization Review Clinician

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

Benefits offered by this job

Medical, Dental, Vision

401(k) match

Employer paid LTD

Employer paid STD

Life and AD&D Insurance

Paid Time Off

Flexible Spending Account

Tuition Reimbursement

Job summary

MiraVista Behavioral Health Center in Holyoke, MA is seeking a Utilization Review Clinician to join our multidisciplinary team onsite.

You will manage pre-certifications, concurrent and discharge reviews, appeals/denials, and monitor contracted quality measures with payors.

Qualifications include a Master's level clinician or RN, licensure eligibility (LMHC/LICSW preferred) or RN, and strong communication and analytical skills.

Qualifications

• Master's level clinician or RN is required or preferred.
• Experience in utilization management, preferably in inpatient psychiatry.
• License eligible (LMHC or LICSW preferred) or RN.
• Knowledge of clinical treatment of psychiatric patients and managed care.
• Strong communication and ability to integrate clinical and financial information.

Responsibilities

• Act as active participant in the healthcare team.
• Handle pre-certification, concurrent and discharge reviews, appeals and denials; ensure compliance with quality measures from managed care organizations.
• Serve as liaison between hospital and payor sources.

Skills

Utilization management

Communication skills

Multidisciplinary teamwork

Fast-paced environment

Clinical knowledge

Education

Master's degree

RN license

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.