Behavioral Health Utilization Management Clinician Reviewer

4 weeks ago


Canton, Massachusetts, United States Point32Health Full time
Job Summary

Point32Health is seeking a skilled Behavioral Health Utilization Management Clinician Reviewer to join our team. As a key member of our Behavioral Health department, you will play a critical role in ensuring timely and appropriate services for our membership while in Behavioral Health acute and intermediate levels of care.

Key Responsibilities:
  • Conduct clinical concurrent and discharge reviews for behavioral health treatment requests to evaluate clinical information and screen for medical necessity of behavioral health services.
  • Collaborate with internal managers and physician advisors to propose alternative plans of treatment when requests for services do not meet medical necessity criteria.
  • Work as a member of the Concurrent Review Team to coordinate the delivery of services to members throughout the continuum of care and interface with providers as needed.
  • Provide information to providers and members regarding behavioral health benefits and treatment resources, and provide telephonic triage and crisis intervention to callers.
  • Identify high-risk/high cost complex members for internal case management and make appropriate referrals, and collaborate closely with Integrated Care Management and Medical Management departments to ensure behavioral, medical and social care management interventions are integrated.
Qualifications:
  • Master's degree in behavioral health related discipline (social work, counseling psychology or related field, nursing).
  • Active unrestricted Massachusetts licensure to practice independently as behavioral health clinician (LICSW, LMHC, LMFT, PhD, PsyD).
  • Minimum of 2 years post-master's direct clinical experience; 3-5 years preferred, with experience with managed care and/or Medicaid a plus.
What We Offer:
  • A dynamic and supportive work environment with opportunities for professional growth and development.
  • A comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and employee assistance program.
  • A commitment to diversity, equity, and inclusion, with a focus on creating a workplace culture that values and respects the contributions of all employees.

Point32Health is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating a workplace culture that is inclusive, respectful, and supportive of all employees. If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply for this exciting opportunity.



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