Base: $81,217.85 - $121,826.77; bonus/equity: not ...
On-site
Adherence to review guidelines and criteria
Prioritization of authorization requests
Concurrent review of services
Point32Health is seeking a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and support the delivery of high-quality healthcare in a team-oriented environment. The ideal candidate will hold a relevant Massachusetts license and have experience in utilization management within a health plan setting
Job Summary
The Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise contract requirements.
Key responsibilities include adherence to established review guidelines, managing authorization requests, and collaborating with external providers to facilitate member access to services.
Point32Health offers a competitive and comprehensive total rewards package including medical, dental, vision coverage, retirement plans, and paid time off.
Matching Summary
Match Score: 85
Point32Health is seeking a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and support the delivery of high-quality healthcare in a team-oriented environment. The ideal candidate will hold a relevant Massachusetts license and have experience in utilization management within a health plan setting.
Salary
Base: $81,217.85 - $121,826.77; 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
Communication with Medical Director
Nice-to-have
Commitment to clinical excellence
Teamwork and collaboration
Professional growth and development
Adaptability to changing needs
Key Requirements
Current unrestricted Massachusetts license
BS Nursing; LICSW, LMHC, or other behavioral health profession
Direct practice clinical experience
Sound knowledge of utilization management principles
Health Plan experience performing utilization review
Experience with McKesson’s InterQual Clinical Screening Criteria