[Remote] BH Clinician (Case Manager)-REMOTE

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health and has been a leader in health solutions for over 90 years. The BH Clinician (Case Manager) is responsible for performing behavioral health duties, ensuring appropriate levels of care, and coordinating care management for members.

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

Skills

• Bachelor degree preferred or relevant experience in lieu of degree
• Requires a minimum of two (2) years behavioral health clinical experience
• Active Unrestricted NJ LCSW, LMFT, LPC or RN License
• Behavioral health experience, preferably in a managed care setting, strongly preferred
• Bi-lingual skills 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

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

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