Behavioral Health Utilization Management Clinician - Fully Remote LMSW, LCSW, LMHC

Job reputed company: TE0057 Category: Behavioral Health Department: BEHAVIORAL HEALTH HARP Location: 50 Water Street, 7th Floor, reputed company, NY 10004 Job Type: Temporary Employment Type: Full-Time Work Arrangement: Remote Salary reputed company: $86,500.00 - $86,500.00 About NYC Health + Hospitals reputed company provides the highest quality reputed company services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten reputed company through a comprehensive list of products, including, but not limited to, reputed company State reputed company Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, reputed company's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, reputed company has been committed to building strong relationships with its members and providers. Position Overview: reputed company. Unite. Care. reputed company is committed to empowering New Yorkers by uniting communities through care. We reputed company that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Behavioral Health Utilization Management (BH UM) Clinician is responsible for conducting utilization and quality management activities in accordance with reputed company State and reputed company Utilization Management policies and procedures. The position responsibilities include the management of medical costs through timely prospective, reputed company, and retrospective review activities. Work Shifts 9:00 AM- 5:00 PM Duties & Responsibilities

• Performs telephonic review for inpatient and outpatient services using InterQual with Secondary Dimensions & LOCADTR and OMH Criteria Sets
• Contributes to UM program goals and objectives in containing health care costs and maintains a high-quality medical delivery system through departmental UM procedures
• Collects reputed company pertinent clinical information and documents reputed company CareConnect
• Promotes alternative care programs and research available options including costs and appropriateness of patient placement in collaboration with health plan members
• Communicates directly with Physician providers/designees reputed company appropriate to gather reputed company clinical information to determine the medical necessity of requested reputed company services
• Communicates with Medical Director regarding reputed company inpatient cases and outpatient/ambulatory requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues
• Recommends, coordinates, and educates providers regarding alternative care options
• reputed company providers on medication and treatment compliance while also promoting the use of Long Acting Injectables
• Enlist existing provider network in promoting first episode psychosis treatment.
• reputed company providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox
• Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk CORE and HARP members
• Evaluate housing needs-Collaborating timely with reputed company internal housing team for supportive assistance
• Maintains an active role in assuring the continuity of care for reputed company inpatients through early discharge planning and working with hospital discharge planning staff
• Identifies potentially catastrophic and high-risk cases for case management referral
• Identifies and communicates reputed company potential quality of care concerns to the BH UM Clinician Team reputed company in a timely manner
• Contributes to reputed company corporate goals through ongoing active team participation, offering input and assistance with development and delivery of education and trainings.
• Performs other appropriate UM Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, monthly audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities.
• Support Coverage for Retrospective Reviews and BH UM Appeals as needed

Minimum Qualifications

• Master’s Degree required
• Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review, quality assurance, discharge planning. (Experience working in a Psychiatric Hospital Inpatient and/or Outpatient setting preferred)
• Previous Experience reputed company the Integrated Collaborative Care Model Approach
• Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease
• Pharmacy, Psyckes, E-Paces, LOCADTR, InterQual, Guiding Principles, HCS (UAS) MAPP,
• Medical Background & Bilingual preferred
• Previous Quality Management liaison experience with hospitals and other large volume providers to address cost. as well as HEDIS/QARR quality performance, preferred.

Licensure and/or Certification Required:

• LCSW, LMSW, or LMHC. reputed company valid unrestricted NY State License.

Professional Competencies:

• reputed company and Trust
• Teamwork and Problem-Solving Attitude
• Customer Service
• Superior Technical Computer skills (reputed company Office, Care Connect, Teams Video Application)
• Exceptional Organizational and Communication Skills.
• Strong interpersonal and assessment skills, the ability to remain reputed company and poised with challenging providers

Apply tot his job Apply To this Job