Behavioral Health Utilization Reviewer, Clinical Access Line

A full-time clinical position focused on the clinical access line for behavioral health. Conduct behavioral health utilization review in order to ensure timely and appropriate level of care of the membership while in BH acute care, diversionary, or ambulatory levels of care and coordination of care. Budgeted salary range is low to mid $50k. Requirements

Ensure that Network Health members receive timely response to requests for behavioral health services and to ensure appropriate level of care of the membership while in acute care, diversionary, or ambulatory levels of care.Conduct precertification reviews of acute/postacute facility LOS and coordinate discharge plans for step-down and ambulatory levels of care and available community resources.Interact with department identifying variances to care coordination and specific payment and level of care situations.Hand-off disease/program specific diagnosis to appropriate case manager for program admission as appropriate.Identify through proactive reviews high-risk, high-cost, complex members for appropriate program case management.Coordinate care with medical and social case management.Communicate with associate medical director regarding identified variances or specific members according to criteria utilized for appropriate level of care.Identify opportunities for improvement and develop action plans when necessary. Additional duties

Collaborate with BH specialists on clinical network management issues.All other related duties as assigned. Qualifications

RN, master's degree in nursing or social work, or doctorate in psychology Two years experience in Concurrent Review/Utilization management in behavioral health acute care or managed care. Two years direct clinical experience Solid understanding of different levels of care in behavioral health Medicaid experience a plus. Familiarity with decision support systems for level of care criteria a plus Excellent interpersonal, communication, and planning skills. Team player RN, LICSW, Clinical Nurse Specialist, or Licensed Psychologist How to apply

Send your resume with a cover letter to careers@network-health.org . Please include the above Job Code in the subject line of your email. Or, mail them to:

Network Health
Attn: Human Resources
101 Station Landing
Fourth Floor
Medford, MA 02155