UR/CM Behavioral Health Clinician

    • Job Tracking ID: 512935-584776
    • Job Location: Meridian, ID
    • Job Level: Mid Career (2+ years)
    • Level of Education: Any
    • Job Type: Full-Time/Regular
    • Date Updated: August 01, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: August 28, 2017
    • Salary Type:: Salary
    • Rate:: Start at $50,000 (DOE)
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Job Description:

Job Summary

The Utilization Review/Case Management Behavioral Health Clinician utilizes advanced clinical judgment, critical thinking skills and medical guidelines in a collaborative process to assess, coordinate, monitor and evaluate options to facilitate appropriate physical and behavioral healthcare services/benefits for members. Coordinates medical and Mental Health/Substance Use Disorder service requests from providers and determines medical necessity using internal guidelines, clinical experience/judgment and the specific requirements of the member’s health plan. Promotes effective utilization of available resources, optimal member functioning, and cost effective outcomes through assessment and member-centered care planning, provider coordination/collaboration, and coordination of psychosocial services.

Key Result Areas

  • Conducts telephonic utilization review/precertification services including, prospective, concurrent and retrospective review utilizing clinical/behavioral health criteria guidelines, clinical judgment and physician advisor review as needed

  • Determines medical necessity and appropriateness of requested inpatient and outpatient services through review of clinical information and application of the appropriate clinical/behavioral health criteria guidelines

  • Assesses the member's current status, future care needs and treatment plan

  • Telephonic communications with members to address their bio-psychosocial needs, identify opportunities for improved health care, and facilitate resources. Use of motivational interviewing to facilitate member empowerment.

  • Communicates with providers and other departments to facilitate care, transitions of care, and discharge planning

  • Identifies solutions to non-standard requests and problems

  • Identifies members for referral opportunities to integrate with other services (i.e. Case Management, Disease Management)

  • Works closely with providers to ensure appropriate utilization of services and effective cost management.

  • Maintains appropriate documentation and records cost management

  • Maintains confidentiality of records and information.

  • Maintains and reports applicable statistics regarding programs and patient services.

  • Attends on-site weekly company/team meetings and monthly staff meetings.

  • Performs all duties within the scope of her/his licensure.

  • After six months of demonstrated efficiency in position, working from home may be possible.

Experience and Skills:

Minimum Qualifications

* Current active and unrestricted Idaho Licensure as LMSW required. LCSW or LCPC preferred.

* Certification in Case Management (CCM) desired.

  • 3-5 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

  • Case management and discharge planning experience required.

  • Managed Care experience preferred.

  • Crisis intervention skills preferred.

  • Knowledge of UR/Case Management functions, self-funded insurance plans, networks and coding.

  • Type 45 words per minute and intermediate level experience in Microsoft Word, Excel, Outlook, and Power Point.

  • Strong interpersonal skills, motivational interviewing skills, and the ability to work effectively with a diverse patient population.

  • Participation on an AmeriBen Pulse Committee is strongly encouraged within 1 year of hire

  • Ability to communicate effectively, both verbally and in writing, medical information to health care professionals, employer groups, brokers, stop loss, internal customers, members and families.

  • Ability to work independently under general instruction and with a team.

  • Time management, organizational, research, analytical, and documentation skills.

  • Ability to work efficiently, independently, perform multi-tasking, prioritize tasks, and meet tight deadlines.

  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.

  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group.