Behavioral Health Utilization Management Clinician

Waltham, MA 02453

Posted: 01/13/2021 Employment Type: Contract Industry: Healthcare Analyst Job Number: 4920928

Job Description

Are you looking to join a full-time healthcare position? Apply today!

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME (Optional) Conduct clinical precertification, concurrent and discharge reviews for behavioral health treatment requests. Evaluate clinical information to screen for medical necessity of behavioral health services and ensure members receive the most appropriate treatment based on their clinical presentation and needs. Consult with internal managers and physician advisors when it appears requests for services do not meet medical necessity criteria, and propose alternative plans of treatment. Work as a member of one of the following teams: Access Line
  • Primary responsibility for outpatient and diversionary levels of care
  • Coordinate plans for additional treatment as needed

CBHI (Children s Behavioral Health Initiative) Team
  • Primary responsibility for CBHI levels of care
  • Coordinate plans for additional treatment as needed

Concurrent Review Team
  • Primary responsibility for acute and post-acute levels of care
  • Coordinate discharge plans to ensure members step down from acute care to an appropriate setting, and coordinate plans for additional treatment as needed

Coordinate the delivery of services to members throughout the continuum of care and interface with providers as needed to ensure appropriate services are being provided. Consult with providers to assist members with transportation, employment and daily living needs as they relate to individualized behavioral health treatment plans. Provide information to providers and members regarding behavioral health benefits and treatment resources. Provide telephonic triage and crisis intervention to callers. Interact with others in a professional, respectful manner that facilitates the treatment process. Identify through proactive concurrent reviews high-risk/high cost complex members for internal case management, and make appropriate referrals. Collaborate closely with Integrated Care Management and Medical Management departments to ensure behavioral, medical and social care management interventions are integrated. Provide back up for peers, including other teams within the Behavioral Health department Identify opportunities for improvement and participate in development of action plans as needed Participate in clinical activities, initiatives and projects to achieve Tufts Health Public Plans goals. Work collaboratively with other departments as appropriate. Adhere to all department and regulatory standards, and ensure all workflow processes are completed within required timeframes. This includes, but is not limited to, standards for documentation of clinical information and authorizations of care. For CBHI Team: Participate in external meetings with various stakeholders, and carry out network management activities throughout the state. All other duties as assigned.

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES EDUCATION: (Minimum education & certifications required)
  • Master s degree in behavioral health related discipline (social work, counseling psychology or related field, nursing)
  • Active unrestricted Massachusetts licensure to practice independently as behavioral health clinician (LICSW, LMHC, LMFT, RN, PhD, PsyD)

EXPERIENCE: (Years of experience)
  • Minimum of 2 years post-master s direct clinical experience; 3-5 years preferred
  • Experience with managed care and/or Medicaid a plus

SKILL REQUIREMENTS: (Include interpersonal skills)
  • Minimum of two years of experience in clinical settings providing direct client care.
  • Solid understanding of the continuum of behavioral health levels of care.

Excellent interpersonal and communication skills. Able to build relationships with and respond to internal and external stakeholders at a variety of levels. Able communicate effectively verbally and electronically. Excellent time management skills. Able to set priorities and complete work within timeframes.
  • Ability to multitask, especially typing while simultaneously conducting utilization reviews.
  • Proficiency with Microsoft applications, including Excel and Word
  • Ability and willingness to work autonomously yet simultaneously interdependently on small to large teams.
  • High adaptability to an ever-changing managed care environment.
  • For CBHI Team: valid driver s license AND access to a vehicle in good working condition to travel to external meetings and network management meetings.

Meet Your Recruiter

Kelly Sonstroem
Client Relationship Manager

Kelly Sonstroem is part of the Panther Professional, New England Group.  Kelly majored in Hospitality Management at Penn State University but found herself gravitating towards recruiting.  She has a love of working with people and understanding what drives the in their careers. Her ability to connect people with opportunities that align with their goals makes her a great resource for anyone in the job hunt!  


Fun Fact:  Last winter she stayed at the ice hotel in Quebec and went dog sledding with her friends and family! 

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