Clinician

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

📋 Description

• Evaluate patients' behavioral health clinical needs against set guidelines to establish the medically appropriate level of care and duration of stay.

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

• Facilitate and support the implementation of member care plans.

• Oversee and coordinate 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 outcome.

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

• Supervise 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 service evaluation.

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

• Accurately document all information in alignment with practice standards and organizational policies.

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

• Evaluate care through problem-solving, analyzing discrepancies, and engaging in quality improvement initiatives.

• Fulfill 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 place of a degree.

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

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

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

• Proficiency in personal computers and Windows-based software, including Microsoft Office 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 knowledge of utilization management principles is preferred.

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

• Knowledge 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 necessary.

• For field-based roles, 100% travel is required.

🏝️ Benefits

• Comprehensive health benefits, including Medical, Dental, and Vision.

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.

• Opportunities for meaningful work that directly enhances lives.

• A mission-driven organization that promotes expertise, collaboration, and growth.