Current unrestricted massachusetts behavioral health license
Direct practice clinical experience in credential area
Knowledge of utilization management principles
Point32Health is a leading not-for-profit organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members
Job Summary
Point32Health is a leading not-for-profit organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.
The BH UM Clinician is responsible for reviewing prior authorization requests, determining medical necessity, and ensuring adherence to regulatory guidelines.
Employees are eligible for a comprehensive total rewards package including medical, dental, vision coverage, retirement plans, and paid time off.
Matching Summary
Point32Health is a leading not-for-profit organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.
Salary
Base: $81,217.85 - $121,826.77 annually; Bonus/Equity: Variable pay eligibility mentioned; Benefits: Medical, dental, vision, retirement, PTO, life insurance, tuition program included
Skills & Requirements
Must-have
Current unrestricted Massachusetts behavioral health license
Direct practice clinical experience in credential area
Knowledge of utilization management principles
Experience with McKesson's InterQual Clinical Screening Criteria
Proficiency with Microsoft Office Word and Excel
Nice-to-have
3 years in managed care environment
Strong communication skills for telephonic interactions
Ability to work collaboratively across multiple organizational levels
Commitment to clinical and service excellence
Experience with case management team referrals
Key Requirements
BS Nursing; LICSW, LMHC, or equivalent independent practice qualification
Current unrestricted Massachusetts license in behavioral health
Minimum direct practice clinical experience required
Health plan experience performing utilization review activities preferred