Clinical Reviewer (inpatient), Behavioral Health

Point32Health

Remote, US
Base: $76,114.60 - $114,171.90; bonus/equity: vari...
Fully remote
Current unrestricted massachusetts license
Bs nursing or licsw/lmhc degree
Direct practice clinical experience
Point32Health is seeking a Clinical Reviewer for inpatient behavioral health services to conduct utilization management and benefit coverage reviews. This fully remote position requires collaboration with behavioral health leadership and adherence to regulatory guidelines, with a schedule of Tuesday to Saturday, 8:30 AM to 5 PM

Job Summary

  • The role involves conducting benefit coverage reviews and utilization management according to regulatory guidelines and contract requirements.
  • Employees must adhere to a specific schedule from Tuesday through Saturday, 8:30 AM to 5 PM.
  • The position offers a comprehensive total rewards package including medical, dental, vision, retirement plans, and paid time off.

Matching Summary

Match Score: 85

Point32Health is seeking a Clinical Reviewer for inpatient behavioral health services to conduct utilization management and benefit coverage reviews. This fully remote position requires collaboration with behavioral health leadership and adherence to regulatory guidelines, with a schedule of Tuesday to Saturday, 8:30 AM to 5 PM.

Salary

Base: $76,114.60 - $114,171.90; Bonus/Equity: Variable pay eligible; Benefits: Medical, dental, vision, retirement, PTO, life insurance

Skills & Requirements

Must-have

  • Current unrestricted Massachusetts license
  • BS Nursing or LICSW/LMHC degree
  • Direct practice clinical experience
  • Knowledge of InterQual criteria
  • Utilization review experience required

Nice-to-have

  • 3 years managed care environment
  • Strong communication skills
  • Team collaboration abilities
  • Adaptability to business changes
  • Proficiency with Microsoft Office

Key Requirements

  • Unrestricted MA behavioral health license
  • BS Nursing, LICSW, LMHC, or equivalent
  • Minimum direct clinical practice experience
  • Experience with McKesson's InterQual criteria
  • Prior health plan utilization review experience

Work Rights

Must have unrestricted Massachusetts license

Tailored Resume

Cover Letter