Utilization Review Clinician in Boston, MA at Beacon Health Options

Date Posted: 2/20/2018

Job Snapshot

Job Description


We are currently seeking a dynamic Utilization Review Clinician to join our team at our office in Boston, MA.  The Utilization Review Clinician will be responsible for authorizing and reviewing utilization of mental health and substance use services provided in inpatient and intermediate care settings; assists with discharge planning and ambulatory follow up activity provides member assistance with mental health and substance use issues, and participates in special utilization projects. 

Position Responsibilities:

1.    Performs telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned

2.    Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria

3.    Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria

4.    Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases

5.    Provides information to members and providers regarding mental health and substance use benefits and community treatment resources

6.    Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources

7.    Identifies and refers high risk members to care management.

8.    Recognizes quality of care issues and reports them appropriately through internal and external processes.

9.    Interacts with providers and facilities in a professional, respectful manner

10. Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.

11. Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned

12. Participates in clinical rounds

13. Assists with NCQA, URAC and other QI initiatives

14. Other duties as assigned

Position Requirements:

Education : Master’s degree or higher required, unless holding active MSN

Licensure :  Current, valid, unrestricted independent license in behavioral health or MSN (LICSW, LMFT, LMHC, or MSN)

Relevant Work Experience:    Minimum two (2) years of combined direct behavioral health clinical and managed care experience.

Knowledge, Skills & Abilities :

•         Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information and facilitate care in multiple settings.

•         Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.

•         Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.

•         Clinicians are required to be educated in current principles, procedures of behavior health care.  Managed care and state specific expertise and knowledge of community resources experience preferred. 


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Beacon Health Options is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled