Clinician

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Execute behavioral health responsibilities following established protocols to guarantee an appropriate level of care and facilitate transitions within the continuum of care.

• Evaluate patients' behavioral health clinical requirements in accordance with established guidelines and standards for suitable inpatient care levels and duration of stay.

• Assess the necessity, appropriateness, and efficiency of medical services and procedures related to behavioral health.

• Collaborate in the coordination and implementation of member care plans.

• Oversee and coordinate out-of-network and out-of-area services, including negotiating internal fees when necessary.

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

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

• Supervise behavioral health care activities and outcomes to ensure their appropriateness and effectiveness.

• Advocate for members and families across various care sites to coordinate resource utilization and assess services.

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

• Accurately and comprehensively document in line with practice standards and organizational policies.

• Communicate with multidisciplinary teams via phone and/or in-person to guarantee continuity and efficiency.

• Evaluate care, analyze variances, engage in quality improvement efforts, and enhance member outcomes.

• Perform additional duties as assigned by management.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• A Bachelor’s degree is preferred, or relevant experience may substitute for a degree.

• At least two (2) years of clinical experience in behavioral health is required.

• Behavioral health experience, ideally in a managed care environment, is highly preferred.

• Must hold an active Unrestricted NJ LCSW, LMFT, LPC, or RN License.

• Proficiency in using personal computers and relevant software in a Windows environment, including MS Office (Word, Excel, PowerPoint) and Lotus Notes is preferred; familiarity with intranet and internet applications is also desired.

• A working knowledge of case/care management principles is preferred.

• A working understanding of utilization management principles is preferred.

• Basic knowledge of health care contracts and benefit eligibility criteria is preferred.

• Familiarity with hospital structures and payment systems is preferred.

• Strong analytical skills.

• Excellent interpersonal and client relationship skills.

• Good judgment, active listening, planning/priority setting, problem-solving, teamwork, time management, written/oral communication, and organizational skills are essential.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement