Jobs

Description

Remote position

Overnight 12a-8a

Weekends and Holidays

Description:

• Assesses patient's behavioral health clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
• Evaluates the necessity, appropriateness and efficiency of behavioral health medical services and procedures provided.
• Coordinates and assists in implementation of plan for members.
• Monitors and coordinates services rendered outside of the network, as well as outside the local area, and coordinates internally for negotiation of fees for such services as appropriate. Coordinates with patient, family, physician,hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Monitors patient's behavioral health medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities,duties, and skills required of each incumbent.

Qualifications: Education/Experience

• Requires a masters in a behavioral health related field or Nursing degree
• Requires a minimum of two (2) years behavioral health clinical experience.
• Behavioral health experience, preferably in a managed care setting, strongly preferred.

Additional licensing, certifications, registrations

• Active Unrestricted NJ LCSW, LMFT, LPC, or RN License Required
• Applied Behavior Analysis Certification preferred 

Knowledge

• Prefers working knowledge of case/care management principles.
• Prefers working knowledge of principles of utilization management.
• Prefers basic knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems.