BH Clinician

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

1d•$70,500 - $94,395

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, evaluates the medical appropriateness and efficiency of behavioral health services, and coordinates care with members, families, providers, facilities, and internal teams. The role monitors care and outcomes across settings, supports member participation, documents in accordance with standards and organizational policies, and contributes to quality improvement and responsible resource utilization. For field-based positions, travel is required 100%. Horizon employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

High school diploma or GED required.
A bachelor’s degree is preferred, or relevant experience may be accepted in lieu of a degree.
At least two years of behavioral health clinical experience required.
Active, unrestricted New Jersey LCSW, LMFT, LPC, or RN license required.

Nice To Haves

Behavioral health experience, preferably in a managed care setting.
Proficiency using personal computers and supporting software in a Windows environment, including MS Office products (Word, Excel, and PowerPoint) and Lotus Notes.
Knowledge of intranet and internet applications.
Working knowledge of case/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.
Analytical, compassionate, interpersonal and client relationship, judgment, listening, planning and priority-setting, problem-solving, teamwork, time-management, written and oral communication, and organizational skills.

Responsibilities

Assess patients’ behavioral health clinical needs against established guidelines and standards to determine the medical appropriateness of inpatient level of care and length of stay.
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, including internal coordination of 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 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 in behavioral health case and disease management programs.
Document accurately and comprehensively according to standards of practice and current organizational policies.
Communicate with multidisciplinary teams by telephone and/or in person to support continuity and efficiency across the continuum of care.
Apply understanding of fiscal accountability and resource utilization in progressing toward 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.