Clinical Care Reviewer II – Behavioral Health

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Conduct thorough prospective, concurrent, and retrospective evaluations of Behavioral Health services.

• Recognize, document, communicate, and coordinate care with partners in collaborative care to ensure a smooth transition to the appropriate level of care.

• Collaborate with the medical director when additional clinical insights are required.

• Stay informed about state and federal regulations, State Contracts, Provider Agreements, benefits, and accreditation standards.

• Detect and refer quality concerns to the Quality Improvement team.

• Identify and refer suitable members for Care Management services.

• Offer guidance to non-clinical personnel.

• Support and mentor LPN staff.

• Participate in medical advisement and State Hearing meetings as requested.

• Assist the Team Leader with special projects or research as needed.

• Carry out other job-related responsibilities as assigned.

⛳️ Requirements

• An Associate of Science (A.S) in Nursing, a Bachelor of Science (B.S) in Social Work, or a Master's degree in a mental health-related field is required.

• A minimum of three (3) years of clinical experience is necessary.

• Current, unrestricted licensure as a Registered Nurse (RN), Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LICSW), Associate Clinical Social Worker (ACSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), or Licensed Mental Health Practitioner (LMHP) is required.

• MCG Certification is mandatory or must be acquired within six (6) months of employment.

• Proficient data entry skills and the ability to efficiently navigate clinical platforms are essential.

• Familiarity with Microsoft Outlook, Word, and Excel is required.

• Strong oral and written communication skills are necessary.

• Capability to work both independently and as part of a team is important.

• Detail-oriented with a strong focus on accuracy.

• Proficient in grammar usage and telephone etiquette.

• Excellent time management and prioritization abilities.

• Customer service-oriented mindset.

• Strong decision-making and problem-solving skills.

• Exceptional organizational capabilities.

• Ability to adapt to change.

• Experience in Utilization Management/Utilization Review is preferred.

• Experience with Medicaid, Medicare, and Commercial insurance is preferred.

🏝️ Benefits

• A bonus linked to both company and individual performance may be available.

• A substantial and comprehensive total rewards package is offered.

• Total well-being support is provided.