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Bh Clinician - Concurrent Review

Company

Horizon Blue Cross Blue Shield of New Jersey
Address , Hopewell, Nj
Employment type FULL_TIME
Salary $67,100 - $89,880 a year
Expires 2023-07-02
Posted at 1 year ago
Job Description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for performing behavioral health duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.
Responsibilities:
  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
  • Evaluates the necessity, appropriateness and efficiency of behavioral health medical services and procedures provided.
  • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
  • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
  • Monitors patient's behavioral health medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
  • 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.
  • Coordinates and assists in implementation of plan for members.
  • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
  • Documents accurately and comprehensively based on the standards of practice and current organization policies.
  • Encourages member participation and compliance in the behavioral health case/disease management program efforts.
  • 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.
  • Completes other assigned functions as requested by management.
  • 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.
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.

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

Additional licensing, certifications, registrations:
  • Applied Behavior Analysist Certification preferred
  • Active Unrestricted NJ LCSW, LMFT, LPC, RN License or Applied Behavior Analysis Certification Required

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

Skills and Abilities:
  • Analytical
  • Listening
  • Interpersonal & Client Relationship Skills
  • Written/Oral Communication & Organizational Skills
  • Problem Solving
  • Planning/Priority Setting
  • Team Player
  • Time Management
  • Compassion
  • Judgment

Travel % (If Applicable):
For field based positions, travel required 100%.
Salary Range:
$67,100 - $89,880
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
  • Retirement Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Incentive Plans
  • Generous PTO
  • Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.