Part Time Behavioral Health Utilization Review Clinician - Remote 6/5/2020
Commonwealth Care Alliance
JOB DESCRIPTIONAPPLY PART TIME BEHAVIORAL HEALTH UTILIZATION REVIEW CLINICIAN - REMOTE
Actual Work Location
Lafayette City Center, Boston, MA
WHY THIS ROLE IS IMPORTANT TO US
At Commonwealth Care Alliance (CCA), our vision is to lead the way in transforming the nation s healthcare for individuals with the most significant needs. If being part of a team and working on combined solutions for patients matters to you keep reading. We may have something to talk about.
The Behavioral Health Utilization Review Clinician will review behavioral health and substance use admissions for medical necessity and appropriate levels of care, negotiating payment levels with facilities and assist with transition of care planning and coordination when a Commonwealth Care Alliance clinician is not already involved. Work with ESP's to ensure appropriate and timely placement for inpatient admission.
This is a part time, 24 hour per week, after-hours, position. The schedule will consist of evening, night, and weekend hours. The anticipated schedule for this role is Friday 12:30am - 9am, Saturday 12:30am - 9am, Sunday 8:30am-5pm. The position will be remote after initial training and orientation with some travel in the community and can be located anywhere in MA.
At CCA, your role matters. You ll be joining an organization that is mission driven, believes in internal mobility, has excellent benefits (see below) and embraces innovation when it comes to serving our patients.
WHAT YOU\'LL BE DOING
* Conduct telephonic preadmission, concurrent and retrospective clinical review of focused behavioral health and substance use inpatient admissions though application of evidence-based medical necessity criteria, CCA policies and procedures, and regulatory and legislative requirements.
* Focus on effective and appropriate utilization of alternative levels of care and collaborate with ICT and Inpatient staff to explore all diversionary services and step-down placements to ensure member receives appropriate level of care in least restrictive environment.
* Determine medical necessity and level of care based on the consistent application of decision support tools, and communicate decisions to facility, providers, treatment team and member.
* Interact with facility staff, primary care teams and other treatment team members to evaluate transition of care needs and prepare member and family for discharge.
* Coordinate authorization and/or delivery of post-acute services and coordinate follow-up care to ensure plans for continuity of care and adherence to quality standards.
* Understand and appropriately manage member s benefits to maximize health care quality.
* Interface with Primary/Interdisciplinary Care Team including Care Coordinator, Care Manager, and others to consult on clinical decision making, optimize member care and ensure safe and effective hand-offs and transitions.
* Position requires the ability to travel to facility or primary care sites within Massachusetts
* Receive, screen, triage and respond to telephone calls from members requiring Behavioral Health clinical direction and advice
WHAT WE\'RE LOOKING FOR
* Master s degree in Behavioral Health field
* Unrestricted license as a LICSW or LMHC in the Commonwealth of MA
* Minimum of 3 years experience in psychiatric and/or substance use health care settings
* Demonstrated knowledge of utilization review procedures
* Demonstrated knowledge of mental health and substance use community resources and network providers
* Skilled in negotiation and motivational interviewing
Does this sound like you* If you re interested in this opportunity, please apply today. The process takes 10-15 minutes. We offer Excellent benefits, including:
Medical, dental and vision plans with low employee contributions
A generous paid time off program
403(b) with company match
Loan Forgiveness Program
Educational Assistance/Reimbursement *
keywords: Behavioral Health, clinician, health care, managed care, master's degree, mental health, social worker, social work, LICSW, LCSW, LPC, LMFT, LMHC, authorization, utilization review, UR, UM, utilization management, referral, member, patient, triage, telephonic, crisis, after hours, remote, telecommute, Boston, Framingham, Springfield, MA, Massachusetts
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.