BH Clinician

Horizon Blue Cross Blue Shield of New Jersey • Hopewell, NJ

3d • $70,500 - $94,395

About The Position

This position performs behavioral health duties using established guidelines to ensure appropriate levels of care and plan transitions across the continuum of care. It performs care-management duties as assigned by management. The clinician assesses behavioral health needs and the medical appropriateness of inpatient care, evaluates services, coordinates care plans and resources, monitors care and outcomes, advocates for members and families, and supports member participation in case or disease management. The role documents care according to standards and organizational policies and collaborates with multidisciplinary teams to promote continuity, efficiency, quality, and cost-effective care.

Requirements

• High school diploma or GED.
• At least two years of behavioral health clinical experience.
• Active, unrestricted New Jersey LCSW, LMFT, LPC, or RN license.

Nice To Haves

• Bachelor’s degree, or relevant experience in lieu of a degree.
• Behavioral health experience, preferably in a managed care setting.
• Proficiency with personal computers and Windows-based software, including Microsoft Office (Word, Excel, and PowerPoint) and Lotus Notes.
• Knowledge of intranet and internet applications.
• Working knowledge of case- or care-management principles.
• Working knowledge of utilization-management principles.
• Basic knowledge of health care contracts and benefit eligibility requirements.
• Knowledge of hospital structures and payment systems.

Responsibilities

• Assess patients’ behavioral health clinical needs against established guidelines and standards to determine whether inpatient level of care and length of stay are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of behavioral health medical services and procedures.
• Coordinate and assist with implementation of plans for members.
• Monitor and coordinate services provided outside the network or local area, and coordinate internally as appropriate to negotiate service fees.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding appropriate care from diagnosis through outcome.
• Coordinate high-quality, cost-effective care across the continuum using clinical practice guidelines established by the plan.
• Monitor behavioral health care activities and outcomes across sites of service for appropriateness and effectiveness.
• Advocate for members and families across care settings to coordinate resource utilization and evaluate services.
• Encourage member participation and compliance with behavioral health case- and disease-management programs.
• Document accurately and comprehensively in accordance with standards of practice and current organizational policies.
• Communicate and collaborate with multidisciplinary teams by telephone or in person to support continuity and efficiency across the continuum of care.
• Apply fiscal accountability and understand its impact on resource utilization and self-care outcomes.
• Evaluate care through problem-solving and variance analysis, and participate in quality improvement to enhance member outcomes.
• Complete other functions assigned by management.

Benefits

• Comprehensive health benefits, including medical, dental, and vision.
• Retirement plans.
• Generous paid time off.
• Incentive plans.
• Wellness programs.
• Paid volunteer time off.
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED