Base: $76,118.26 - $114,177.38; bonus/equity: not ...
On-site
Adherence to review guidelines and criteria
Prioritization of authorization requests
Concurrent review of services
Point32Health Inc. is seeking a Clinical Reviewer in Behavioral Health for their Canton, MA location. The role involves conducting utilization management reviews and ensuring compliance with healthcare regulations, while the company emphasizes a culture of community care and inclusion
Job Summary
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare.
The Behavioral Health UM Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines.
Point32Health offers a competitive and comprehensive total rewards package including medical, dental, vision, retirement plans, and paid time off.
Matching Summary
Match Score: 85
Point32Health Inc. is seeking a Clinical Reviewer in Behavioral Health for their Canton, MA location. The role involves conducting utilization management reviews and ensuring compliance with healthcare regulations, while the company emphasizes a culture of community care and inclusion.
Salary
Base: $76,118.26 - $114,177.38; Bonus/Equity: Not specified; Benefits: Medical, dental, vision, retirement plans, PTO, life and disability insurance, tuition program, well-being benefits
Skills & Requirements
Must-have
Adherence to review guidelines and criteria
Prioritization of authorization requests
Concurrent review of services
Identification of benefit coverage
Effective communication with Medical Director
Collaboration with external providers
Nice-to-have
Commitment to clinical and service excellence
Teamwork and collaboration
Professional growth and development
Adaptability to changing needs
Key Requirements
Current unrestricted Massachusetts license
BS Nursing; LICSW, LMHC, or equivalent
Direct practice clinical experience
Sound knowledge of utilization management
Health Plan experience performing utilization review
Experience with McKesson’s InterQual Clinical Screening Criteria