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H
Clinician
Horizon Connect @ Wall BCBSNJ. Perform behavioral health duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in behavioral health clinical assessment, care coordination, and utilization management, ensuring high-quality, cost-effective care across various settings. Proficient in advocating for members and families while effectively communicating with multidisciplinary teams.
Highest-signal resume keywords
Behavioral Health Clinical ExperienceActive Unrestricted NJ LCSW, LMFT, LPC or RN LicenseUtilization Management PrinciplesCase/Care Management PrinciplesMS Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health AssessmentCare CoordinationQuality ImprovementResource Utilization EvaluationClinical Practice GuidelinesDocumentation StandardsProblem SolvingAnalytical SkillsHealth Care Contracts KnowledgePayment Systems Knowledge
Soft Skills
Interpersonal SkillsCompassionJudgmentTime ManagementWritten/Oral Communication
Tools & Technologies
Windows Based EnvironmentMS Office ProductsLotus Notes
Certifications & Qualifications
High School Diploma/GEDBachelor's Degree PreferredTwo Years Behavioral Health Experience
Industry Keywords
Managed Care SettingContinuum of CareInpatient CareMember Care PlansOut-of-Network Services
About the role
Key responsibilities & impact- Perform behavioral health duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care
- Assess patients' behavioral health clinical needs against established guidelines and standards for medically appropriate inpatient care and length of stay
- Evaluate the necessity, appropriateness and efficiency of behavioral health medical services and procedures
- Coordinate and assist in implementing member care plans
- Monitor and coordinate out-of-network and out-of-area services, including fee negotiations as appropriate
- Coordinate with patients, families, physicians, hospitals and external customers regarding appropriateness of care from diagnosis to outcome
- Coordinate high-quality, cost-effective care across the continuum using clinical practice guidelines
- Monitor behavioral health care activities and outcomes for appropriateness and effectiveness
- Advocate for members and families across care sites to coordinate resource utilization and evaluate services
- Encourage member participation and compliance in behavioral health case/disease management programs
- Document accurately and comprehensively according to standards of practice and organizational policies
- Communicate with multidisciplinary teams telephonically and/or in person to promote continuity and efficiency
- Evaluate care, solve problems, analyze variances and participate in quality improvement programs
- Complete other assigned functions as requested by management
Requirements
What you’ll need- High School Diploma/GED required
- Bachelor's degree preferred or relevant experience in lieu of degree
- Requires a minimum of two (2) years behavioral health clinical experience
- Behavioral health experience, preferably in a managed care setting, strongly preferred
- Active Unrestricted NJ LCSW, LMFT, LPC or RN License
- Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes
- 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
- Analytical, compassion, interpersonal and client relationship skills, judgment, listening, planning/priority setting, problem solving, team player, time management, written/oral communication and organizational skills
- Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Benefits
Comp & perks- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement