BH Clinician

Horizon Healthcare Services•Hopewell, NJ

About The Position

This position performs behavioral health duties using established guidelines to ensure an appropriate level of care and plan transitions across the continuum of care. The clinician performs care management duties as assigned by management. The role assesses clinical needs, evaluates the medical appropriateness and efficiency of services, coordinates care among members and providers, monitors outcomes, and supports member participation in behavioral health case or disease management programs.

Requirements

High school diploma or GED required.
At least two years of behavioral health clinical experience required.
Active, unrestricted New Jersey LCSW, LMFT, LPC, or RN license required.
For field-based positions, travel is required 100%.
Skills and abilities include analytical ability, compassion, interpersonal and client relationship skills, judgment, listening, planning and priority setting, problem solving, teamwork, time management, and written, oral, and organizational skills.

Nice To Haves

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

Responsibilities

Assess patients’ behavioral health clinical needs against established guidelines or 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 care plans for members.
Monitor and coordinate services provided outside the network or local area, and coordinate internally on fee negotiations when appropriate.
Coordinate with patients, families, physicians, hospitals, and other external customers regarding appropriate care from diagnosis through outcome.
Coordinate high-quality, cost-effective care using clinical practice guidelines across the continuum of care.
Monitor behavioral health care activities across sites of service and evaluate appropriateness and effectiveness of outcomes.
Advocate for members and families across care settings to coordinate resource utilization and evaluate services.
Encourage member participation and compliance in behavioral health case or disease management programs.
Document accurately and comprehensively according to standards of practice and current organizational policies.
Communicate with multidisciplinary teams by phone and/or in person to support continuity and efficiency across the continuum of care.
Consider fiscal accountability and its impact on resource utilization in pursuit of self-care outcomes.
Evaluate care, solve problems, analyze variances, and participate in quality improvement activities to enhance member outcomes.
Complete other functions assigned by management.