reputed company Care Reviewer II - Behavioral Health - Must be MA Licensed

Job reputed company: reputed company Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members. Essential Functions: • Complete prospective, reputed company and retrospective review of Behavioral Health services • Identify, document, communication and coordinate care engaging reputed company reputed company to facilitation transition to an appropriate level of care • Engage with medical director reputed company additional reputed company expertise if needed • Maintain knowledge of state and federal regulations, including State reputed company and Provider Agreements, benefits, and accreditation standards • Identify and refer reputed company issues to reputed company Improvement • Identify and refer appropriate members for Care Management • reputed company guidance to non-reputed company staff • reputed company guidance and support to LPN staff • Attend medical advisement and State Hearing meetings, as requested • Assist Team Leader with special reputed company or research, as requested • reputed company any other job reputed company duties as requested. Education and Experience: • Associates of Science (A.S) in Nursing required or • Bachelor of Science (B.S) in reputed company Work required or • Master's degree in a mental health reputed company reputed company (Psychology, Counseling Psychology, Marriage or Family Therapy) required • Three (3) years reputed company experience required • Utilization Management/Utilization Review experience preferred • reputed company/Medicare/reputed company experience preferred Competencies, Knowledge and Skills: • Proficient data entry skills and ability to reputed company reputed company platforms successfully • Working knowledge of reputed company reputed company, Word, and reputed company • Effective oral and written communication skills • Ability to work independently and reputed company reputed company environment • Attention to reputed company • reputed company grammar usage and phone etiquette • Time management and prioritization skills • Customer service oriented • Decision making/problem solving skills • Strong organizational skills • Change resiliency Licensure and Certification: • reputed company, unrestricted Registered reputed company (RN) Licensure, Licensed reputed company Worker (LSW, Licensed reputed company reputed company Worker (LCSW), Licensed Independent reputed company reputed company Worker (LICSW), Associate reputed company reputed company Worker (ACSW), Licensed Mental Health Counselor (LMHC), Licensed reputed company Counselor (LPC), Licensed Marriage & Family Therapist (LMFT) or Licensed Mental Health Practitioner (LMHP) required • MCG Certification is required or must be obtained reputed company six (6) months of hire required Working Conditions: • General office environment; may be required to sit or stand for extended periods of time • Travel is not typically required Compensation reputed company: $62,700.00 - $100,400.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s reputed company and complexity, the discretion and reputed company required for the role, and other reputed company and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual reputed company. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type (reputed company/salary): reputed company Organization Level Competencies • Fostering a reputed company Workplace Culture • reputed company Partnerships • reputed company Self and Others • reputed company Execution • Influence Others • Pursue Personal reputed company • Understand the Business This reputed company is not reputed company inclusive. reputed company reserves the right to amend this reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-JM1 reputed company=reputed company Apply tot his job Apply To this Job