About the position The Behavioral Health Clinician at Horizon Blue Cross Blue Shield of Jersey is responsible for performing behavioral health duties in accordance with established guidelines to ensure appropriate levels of care. This role involves assessing patients' clinical needs, coordinating care, and advocating for members and their families throughout the continuum of care. The clinician will work closely with multidisciplinary teams to monitor and evaluate the effectiveness of care provided, ensuring high-quality and cost-effective services.
Responsibilities Assesses patient's behavioral health clinical need against established guidelines to ensure appropriate level of care. Evaluates the necessity, appropriateness, and efficiency of behavioral health medical services and procedures provided. Coordinates and assists in the implementation of care plans for members. Monitors and coordinates services rendered outside of the network and negotiates fees for such services as appropriate. Coordinates with patients, families, physicians, hospitals, and other external customers regarding care appropriateness. Delivers high-quality, cost-effective care supported by clinical practice guidelines. Monitors patient's behavioral health medical care activities and outcomes for appropriateness and effectiveness. Advocates for members/families among various sites to coordinate resource utilization and evaluation of services. Encourages member participation and compliance in behavioral health case/disease management programs. Documents accurately and comprehensively based on standards of practice and organization policies. Interacts and communicates with multidisciplinary teams to ensure continuity and efficiency in care management. Understands fiscal accountability and its impact on resource utilization. Evaluates care by problem-solving, analyzing variances, and participating in quality improvement programs. Completes other assigned functions as requested by management.
Requirements High School Diploma/GED required. Bachelor's degree preferred or relevant experience in lieu of degree. Minimum of two (2) years behavioral health clinical experience required. Behavioral health experience in a managed care setting strongly preferred. Active Unrestricted NJ LCSW, LMFT, LPC, RN License or Applied Behavior Analysis Certification required. Applied Behavior Analyst Certification preferred.
Nice-to-haves Proficiency in the use of personal computers and supporting software in a Windows-based environment, including MS Office products. Working knowledge of case/care management principles. Working knowledge of principles of utilization management. Basic knowledge of health care contracts and benefit eligibility requirements. 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