BH Clinician

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Evaluate patients' behavioral health clinical requirements in accordance with established guidelines and standards to establish the medically appropriate level of care and duration of inpatient stay.

• Assess the necessity, suitability, and efficiency of behavioral health medical services and procedures.

• Facilitate and assist in the execution of member care plans.

• Oversee and organize out-of-network and out-of-area services, including internal fee negotiations when applicable.

• Collaborate with patients, families, physicians, hospitals, and external stakeholders regarding care from diagnosis to outcome.

• Ensure high-quality, cost-effective care throughout the continuum by utilizing established clinical practice guidelines.

• Supervise behavioral health care activities and results for appropriateness and effectiveness across various service sites.

• Advocate for members and their families across different care settings to optimize resource utilization and assess services.

• Promote member engagement and adherence in behavioral health case/disease management programs.

• Maintain accurate and comprehensive documentation in line with practice standards and organizational policies.

• Interact with multidisciplinary teams via telephone and/or in person to enhance continuity and efficiency.

• Apply fiscal responsibility in the use of resources and self-care outcomes.

• Assess care, troubleshoot issues, analyze discrepancies, and engage in quality improvement initiatives.

• Complete additional tasks as assigned by management.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• A Bachelor’s degree is preferred, or relevant experience may be considered in lieu of a degree.

• A minimum of two (2) years of clinical experience in behavioral health is required.

• Behavioral health experience, particularly in a managed care environment, is strongly preferred.

• Active and Unrestricted NJ LCSW, LMFT, LPC, or RN License is required.

• Proficiency in personal computer usage and relevant software in a Windows environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes is preferred.

• Familiarity with intranet and internet applications is preferred.

• Basic understanding of case/care management principles is preferred.

• Basic knowledge of utilization management principles is preferred.

• Fundamental knowledge of healthcare contracts and eligibility requirements is preferred.

• Awareness of hospital structures and payment systems is preferred.

• Strong analytical, compassionate, interpersonal, and client relationship skills, as well as good judgment, listening ability, planning/priority setting, problem-solving, teamwork, time management, written/oral communication, and organizational skills.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement