• Behavioral Health On-Call Clinician Full Time Remote

    Job ID
    2019-2740
    Category
    Clinical (Home Health)
    Type
    Regular Full-Time
    Actual Work Location
    CCC Clinic, 30 Northampton Street, Boston, MA
  • Why This Role is Important to Us

    Under the guidance of the Clinical Director, the Behavioral Health On-Call Clinician will manage clinical phone calls for Commonwealth Care Alliance (CCA) providers seeking authorizations, referrals, member care, and benefits related to Behavioral Health needs.  

     

    This is a full-time, 40-hour per week, position. The schedule will consist of evening and weekend hours. The position will be remote after initial training and orientation with some travel in the community. 

    What You'll Be Doing

    • Effectively negotiate and influence patient care and health care outcomes.
    • Receive, screen, triage, and respond to telephone calls from members requiring Behavioral Health clinical direction and advice.
    • Demonstrate clinical assessment skills by Identifying urgent and emergent situations and effectively triage the member to an appropriate level of care per protocols.
    • Perform telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned.
    • Determine the most appropriate level of care based on CCA medical necessity criteria.
    • Appropriately document calls received with adherence to required standard documentation, meeting all timeliness deadlines and follow-up.
    • Respond to provider and facility questions related to member clinical summary and status of referrals and authorizations.
    • Ability to work with the emergency services teams to assess and assign members to CCA’s own and other providers Crisis Stabilization Unit. 
    • Demonstrate an ability to make quick decisions, based on sound base of critical thinking skills
    • 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.
    • Assist in the collection of key metrics that drive our KPI’s of BH members that are in the emergency department, inpatient setting and CSU’s.
    • Report any quality of care concerns to the appropriate CCA team.

     

     

    What We're Looking For

    Education: Master’s degree or higher in health-related field required.

     

    Licensure: Current, valid and unrestricted licensure in mental/behavioral health (LICSW, LCSW, LPC, LMFT, or LMHC) required.

     

    Experience:

    • Minimum - 3 years combined direct behavioral health, supervisory and/or managed care experience required.
    • Preferred - 5+ years combined direct behavioral health, supervisory and/or managed care experience.
    • Working knowledge of account management, customer relations and business management are essential.
    • Strong customer service orientation, excellent written and verbal communication skills, and experience using management information systems.
    • Knowledge and experience related to clinical services and managed care preferred.

     

    keywords: Behavioral Health, clinician, health care, managed care, master's degree, mental health, social worker, social work, LICSW, LCSW, LPC, LMFT, LMHC, uthorization, referral, member, patient, triage, telephonic, crisis, remote, telecommute, Boston, MA, Massachusetts

     

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