Clinical Reviewer, Behavioral Health

Harvard Pilgrim Health Care Inc

Canton, MA, United States
Base: $76,118.26 - $114,177.38; bonus/equity: vari...
Fully remote
Behavioral health utilization management
Conduct benefit coverage reviews
Adherence to review guidelines
Point32Health is a not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members

Job Summary

  • Point32Health is a not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.
  • The Behavioral Health Utilization Management Clinician conducts benefit coverage reviews and utilization management according to regulatory guidelines and contract requirements.
  • The role involves collaboration with internal teams and external providers to ensure clinically appropriate delivery of services and member access to care.

Matching Summary

Point32Health is a not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.

Salary

Base: $76,118.26 - $114,177.38; Bonus/Equity: Variable pay eligible; Benefits: Medical, dental, vision, retirement, PTO, life/disability insurance, tuition program, well-being benefits

Skills & Requirements

Must-have

  • Behavioral health utilization management
  • Conduct benefit coverage reviews
  • Adherence to review guidelines
  • Prior authorization requests review
  • Concurrent review of services

Nice-to-have

  • Teamwork and collaboration
  • Service excellence
  • Professional growth and development
  • Empathy and understanding needs

Key Requirements

  • Current unrestricted MA behavioral health license
  • BS Nursing; LICSW, LMHC, or equivalent
  • Direct practice clinical experience
  • Sound knowledge of UM/CM principles
  • Health plan UM review experience

Work Rights

Not specified

Tailored Resume

Cover Letter