Behavioral Health Clinician

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About the position

Responsibilities

  • Assesses patient's behavioral health clinical need against established guidelines to ensure appropriate level of care.
  • Evaluates the necessity, appropriateness, and efficiency of behavioral health medical services and procedures provided.
  • Coordinates and assists in the implementation of care plans for members.
  • Monitors and coordinates services rendered outside of the network and negotiates fees for such services as appropriate.
  • Coordinates with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
  • Delivers high-quality, cost-effective care supported by clinical practice guidelines.
  • Monitors patient's behavioral health medical care activities and outcomes for appropriateness and effectiveness.
  • Advocates for members/families among various sites to coordinate resource utilization and evaluation of services.
  • Encourages member participation and compliance in behavioral health case/disease management programs.
  • Documents accurately and comprehensively based on standards of practice and organization policies.
  • Interacts and communicates with multidisciplinary teams to ensure continuity and efficiency in care management.
  • Understands fiscal accountability and its impact on resource utilization.
  • Evaluates care by problem-solving, analyzing variances, and participating in quality improvement programs.
  • Completes other assigned functions as requested by management.

Requirements

  • High School Diploma/GED required.
  • Bachelor's degree preferred or relevant experience in lieu of degree.
  • Minimum of two (2) years behavioral health clinical experience required.
  • Behavioral health experience in a managed care setting strongly preferred.
  • Active Unrestricted NJ LCSW, LMFT, LPC, RN License or Applied Behavior Analysis Certification required.
  • Applied Behavior Analyst Certification preferred.

Nice-to-haves

  • Proficiency in the use of personal computers and supporting software in a Windows-based environment, including MS Office products.
  • Working knowledge of case/care management principles.
  • Working knowledge of principles of utilization management.
  • Basic knowledge of health care contracts and benefit eligibility requirements.
  • Knowledge of hospital structures and payment systems.

Benefits

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement
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