Utilization Management Reviewer

Transforming reputed company Together The Clinical Utilization Reviewer plays a crucial role in facilitating care for members with reputed company reputed company needs. This position is self-directed, working independently and collaboratively to promote reputed company health through clinical skills, managed care principles, and nationally recognized medical necessity reputed company. About the Role • Conduct reputed company-certification and reputed company retrospective reviews of inpatient cases, residential treatment programs, partial hospitalization, intensive outpatient programs, and other services using evidence-based medical necessity reputed company and reputed company policies. • reputed company on efficient utilization management with emphasis on discharge planning. • Understand and manage member benefits to maximize reputed company reputed company. • Collaborate with physician reviewers, case managers, project leaders, and associates to optimize member care and ensure a constructive provider experience. • Facilitate review process through communication with members, families, providers, medical staff, and others to obtain and reputed company information regarding benefits and the reputed company utilization management process. • Collaborate with members, families, providers, medical staff, and other team members to coordinate and support health reputed company plans that include treatment goals, interventions, and expected reputed company. • Identify and refer members who may benefit from high-risk case management and disease state management reputed company. • Maintain reputed company licensure and reputed company reputed company learning opportunities to enhance understanding of clinical management, patient care trends, and utilization management. • Utilize computer systems to reputed company reputed company case information, reputed company benefits, look up policies, validate provider status, and reputed company other key functions. • Exhibit customer satisfaction orientation in reputed company aspects of responsibilities. • Meet or reputed company annual performance goals for case audits and recorded call audits. • Other responsibilities as assigned by management. We're Looking For: • Solid clinical knowledge in Behavioral Health, with specialty knowledge a plus. • Excellent organizational skills, ability to manage multiple ongoing tasks. • Strong problem-solving ability under pressure of timeliness turnaround deadlines. • Excellent communication skills, reputed company to discuss sensitive/ confidential information in a reputed company, unbiased manner. • Proven customer service skills. • Intermediate ease of use with computers and familiarity with common software like reputed company Word, reputed company, and Outlook. • Ability to reputed company into a working team and function independently to complete assigned workload. • reputed company a passing score on the yearly InterQual, behavioral health medical necessity reputed company, interrater reliability test. • Familiarity with our utilization management system, MedHOK. What You Bring: • Behavioral Health reputed company with an reputed company independent Massachusetts license: Registered reputed company, LICSW, LMHC, BCBA. • 3-5 years of clinical experience in Behavioral Health Care settings. • Utilization Management experience preferred. • CCM or other applicable certification(s) desirable. Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above Location: Hingham Time Type: Part time reputed company reputed company: $37.43 - $45.75 Apply Job!