Clinician

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

📋 Description

• Execute behavioral health responsibilities in accordance with established protocols to guarantee the proper level of care and facilitate transitions within the continuum of care.

• Evaluate patients' behavioral health clinical requirements based on established guidelines and standards for medically suitable inpatient care and duration of stay.

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

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

• Oversee and coordinate out-of-network and out-of-area services, including fee negotiations when necessary.

• Collaborate with patients, families, physicians, hospitals, and external stakeholders regarding the appropriateness of care from diagnosis through to outcomes.

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

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

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

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

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

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

• Evaluate care, resolve issues, analyze variances, and engage in quality improvement initiatives.

• Perform additional tasks as assigned by management.

⛳️ Requirements

• A High School Diploma or GED is required.

• A Bachelor's degree is preferred, or equivalent relevant experience may substitute for the degree.

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

• Experience in behavioral health, particularly within a managed care environment, is highly preferred.

• An active and unrestricted NJ LCSW, LMFT, LPC, or RN license is necessary.

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

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

• Familiarity with the principles of utilization management is required.

• Basic understanding of healthcare contracts and benefit eligibility requirements is necessary.

• Knowledge of hospital systems and payment structures is expected.

• Strong analytical, compassionate, interpersonal, and client relationship skills, along with sound judgment, listening abilities, planning/prioritization, problem-solving capabilities, teamwork, time management, and effective written/oral communication and organizational skills are essential.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits package (Medical/Dental/Vision).

• Retirement plans available.

• Generous paid time off (PTO).

• Incentive plans offered.

• Wellness programs provided.

• Paid volunteer time off.

• Tuition reimbursement opportunities.