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Horizon Blue Cross Blue Shield of New Jersey · 2 weeks ago

BH Clinician

United States

Full-time

Remote

Entry, Mid Level

$70K/yr - $94K/yr

2+ years exp

Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and is seeking a BH Clinician to perform behavioral health duties. The role involves assessing patient needs, coordinating care, and ensuring appropriate treatment plans are implemented.

Health Care

Responsibilities

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

Encourages member participation and compliance in the behavioral health case/disease management program efforts

Documents accurately and comprehensively based on the standards of practice and current organization policies

Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care

Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes

Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes

Completes other assigned functions as requested by management

Qualification

Masters in Behavioral HealthBehavioral Health ExperienceActive NJ LCSW/LMFT/LPC/RNApplied Behavior Analysis CertificationCase Management PrinciplesUtilization Management PrinciplesAnalyticalCompassionJudgmentPlanning/Priority SettingInterpersonal SkillsListeningProblem SolvingTeam PlayerTime ManagementWritten/Oral Communication

Required

Requires a masters in a behavioral health related field or Nursing degree

Requires a minimum of two (2) years behavioral health clinical experience

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

Preferred

Behavioral health experience, preferably in a managed care setting, strongly preferred

Applied Behavior Analysist Certification preferred

Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications

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