• conduct prior authorization reviews for ABA treatment services • evaluate clinical documentation for medical necessity • monitor clinical effectiveness and efficiency of member's care according to ABA guidelines • analyze BH member data to improve service utilization • interact with BH healthcare providers to discuss care and services

• Provide clinical review of services for members or enrollees with mental health, substance use, and/or developmental disabilities including diagnosis review, medical necessity criteria, determining member eligibility; level of care needed and making service authorization decisions regarding individual service authorizations with timely, clear, concise documentation. • Provide clinical triage for members seeking services through Screening, Triage and Referral. • Provide consultation and technical assistance to providers regarding clinical care needs, levels of care, Client Rights Rules, evidenced based practices, scope of practice issues etc. • Provide ongoing review/staffing/consultation of treatment documentation of needs for members participating in group, family or individual services.

Role Description - Conducts assessments and psychosocial evaluations on patients using criteria established by the Diagnostic and Statistical Manual of the American Psychiatric Association. - Assesses and implements the crisis plan and crisis intervention for high-risk patients (i.e. suicidal, homicidal, psychotic, aggressive) using appropriate skills and assessments. - Maintains current knowledge/level of expertise in area of specialty and various treatment modalities. - Identifies and works to resolve barriers to patients seeking and receiving behavioral health services. - Adheres to the professional standards and code of ethics set forth by applicable licensing board. - Demonstrates the ability to effectively communicate (written and verbal) with clarity and organization while ensuring appropriate communication occurs between the medical staff, leadership team, service line leadership, and team members. - Documents relevant assessment and progress updates in the medical record according to departmental standards. - Demonstrates effective decision making in a rapid-paced environment with attention to detail utilizing logical and appropriate clinical judgment. - Participates in development, implementation, evaluation, and revision of departmental policies and procedures. Qualifications - Master's degree in a relevant human services field such as Social Work, Counseling, Psychology, or Marriage and Family Therapy from an accredited school of graduate education required or an Associate's degree in Nursing; Bachelor's degree in Nursing preferred. - Full current licensure in the state of applicable state required. - 2 years of clinical experience required. Requirements - Works in the Call Center, but also areas including patient care units, emergency rooms, individual offices, and conference areas with exposure to potentially hostile patients. - Work requires frequent moving from one area to another, answering telephones, and coordinating and communicating with other staff persons in various disciplines and agencies. Benefits - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training. - Premium pay such as shift, on call, and more based on a teammate's job. - Incentive pay for select positions. - Opportunity for annual increases based on performance. - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program. - Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

• Provide timely crisis assessment and intervention via phone, video, or in person • Conduct Zero Suicide screenings and risk evaluations • Make clinically sound decisions to stabilize individuals and refer to appropriate services • Coordinate care with internal teams and external community partners • Deliver culturally responsive, trauma-informed care • Document services accurately and maintain compliance with agency and state standards • Participate in supervision and collaborate with multidisciplinary teams • Regional travel required; hybrid work environment with office-based shifts required