Clinician

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

📋 Description

• Execute behavioral health responsibilities in accordance with established guidelines to ensure suitable care levels and facilitate transitions throughout the care continuum.

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

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

• Assist in coordinating and implementing member care plans.

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

• Collaborate with patients, families, physicians, hospitals, and external stakeholders regarding care from diagnosis 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 various care sites to optimize resource utilization and evaluate 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.

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

• Evaluate care, address issues, analyze discrepancies, and engage in quality improvement initiatives.

• Perform additional assigned tasks as requested 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.

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

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

• Familiarity with intranet and internet applications is preferred.

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

• A working understanding of utilization management principles is preferred.

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

• Understanding of hospital structures and payment systems is preferred.

• Strong analytical, interpersonal, client relationship, judgment, listening, planning/priority setting, problem-solving, time management, written/oral communication, and organizational skills are essential.

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

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement