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UM Clinical Specialist-Behavioral Health
Location
United States
Posted
113 days ago
Salary
0
No structured requirement data.
Job Description
UM Clinical Specialist-Behavioral Health
Alliance
The UM Clinical Specialist-Behavioral Health performs professional and administrative work, primarily utilization reviews, utilization management and active care management to ensure economical and effective consumer service delivery by PHIP enrolled network providers; The position is responsible for providing medical necessity reviews of individualized service plans and requests for authorization of services to ensure consumers receive services in the least restrictive, most integrated setting appropriate to the individual’s needs; The primary role is to review for services under the Medicaid B waiver and state funded benefits; complete related work as required. This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office at Morrisville may be required. Responsibilities & Duties Utilization Reviews and Management Independently conducts medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times Conducts utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested Engage in care management activities to ensures individuals receive appropriate referral for treatment including; consumer and provider follow-up calls, case staffing with psychologists and medical staff Monitors consumer person centered plans to ensure that effective treatment interventions are utilized, provide consultation to treating providers when person centered plan requires adjustments to better meet consumer needs Monitors and reports consumer and provider specific over/under utilization Conducts utilization reviews to monitor for over/under utilization Program Operation and Management Identify high risk consumers and those with special health care needs for referral to Care Coordination and case escalation Provides linkage, authorizations and level of care determinations, assisting providers and Care Coordinators with creative problem solving to recommend alternative approaches to care Ensures compliance with care management and quality improvement policies and procedures, utilization review laws and regulations, state standards Promote access to appropriate, effective and quality treatment Monitors for undesirable performance or deviations of practice standards through care management activities that may have a negative impact on consumers. Responds through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO Administrative Functions Notifies members of adverse benefit determinations while preserving members’ Due Process rights Engages in routine follow-up to ensure consumers are engaged in treatment and services are being delivered as requested Documents utilization review decisions in computerized authorization management system Maintain professional licensure Engages in training as needed to stay informed of changes in best practice for supporting the needs of individuals with MH/SUD/IDD Minimum Requirements Education & Experience : Master’s degree in a Human Services field (such as Psychology, Social Work or Counseling) and at least five years of post-degree progressive experience providing similar services to the population served (MH/SUD). Requires current and active license issued by a North Carolina Professional Board, as a LCSW, LCAS, LP, LPA, LMFT, LCMHC or RN. OR A master's degree in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform this work; or graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience. Preferred : Experience in the public behavioral healthcare field is highly desired due to the complexity of the work. Experience in a UM environment in Behavioral Healthcare would be valuable for this employee. Knowledge, Skills, & Abilities Considerable knowledge of case management principles, practices and applications Considerable knowledge of agency and community programs and services which affect clients and applicants Knowledge of state and federal client rights protection statues and regulations applicable laws and regulations including but not limited to URAC, applicable Code of Federal Regulations and NC Administrative Code Effective written and oral communication skills and interpersonal and presentation skills Ability to identify rights protection complaint issues; ability to set, monitor and evaluate standards for quality and to assess plans to measure how they meet the needs of individual clients Considerable knowledge in DMS 5 diagnostic criteria Ability to manage time, prioritize work and use problem-solving approaches Ability to coordinate effectively with staff from a various agencies as well as inter-departmental Ability to read, analyze, and interpret regulations, policies and procedures Coordinate work with a variety of individuals and agencies Ability to operate computer equipment and generate reports and records; ability to express ideas clearly and concisely orally and in written documents Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required Employment for this position is contingent upon a satisfactory background check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. Salary Range $68,227 - $86,990/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long and Short Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility
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Resumes can be confidentially faxed to 541-479-3514 or apply online at www.optionsonline.org and click on Jobs. Generous salary, signing bonus, moving allowance, 6% agency retirement match, robust individual and family benefits, professional development allowance, the possibility of loan repayment programs, and more. Part-time to Full-time: M-F or 4 days per week. Outpatient/Residential setting, in-person or Telehealth possible. Overview Looking for a dynamic adult psychiatrist to join our team of providers. The Psychiatrist provides medication management and consultation to our interdisciplinary teams. Our teams consist of psychiatric providers, medical assistants, nurses, therapists, case managers, skills trainers, substance abuse treatment providers, peers and others. Works in partnership with primary care providers to treat our clients. The Providers caseload will include adults 18 and older, and work one day in psychiatric residential care. Independent contractors are encouraged to apply through this process. Responsibilities Diagnoses, treats and helps prevent mental, emotional, and behavioral disorders. Prescribes, directs and administers psychotherapeutic treatments and medications. Reviews, evaluates and collaborates with other professionals regarding treatment plans, client progress and outcomes. Confers on the diagnosis and direction of treatment with client, significant others, agency clinicians, and with client’s other treatment providers. Develops and maintains therapeutic client relationships with close adherence to client-directed services. Prescribes medication and performs other therapeutic measures for the treatment of psychiatric disorders. Explains medication effects and side-effects to the client and/or guardian. Reviews, approves, and signs Treatment Plans and Assessments for assigned clients. Participates in mental health and service utilization audits, peer review, and quality assurance activities. Facilitates referrals to appropriate internal and/or external resources where indicated. Provides consultation and education services within the agency, to consumers, and with community partners as needed. Participates in program development as requested. Attends all mandatory meetings, participates in regular individual and group supervision. Maintains positive working relationships. Works as an active and cooperative member of the treatment team. Participates in phone response on-call schedule. Manages time and caseload effectively. Candidate must be able to work independently and flexibly under general supervision. Qualifications Position requires Oregon licensure (MD or DO). BC/BE preferred. Computer proficiency required to use Electronic Health Records. Must successfully complete state-required background and DMV checks. Valid OR driver’s license with a satisfactory driving record required. Options for Southern Oregon provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
