Clinician

• Perform clinical reviews and assess care related to mental health and substance abuse
• Monitor and determine whether levels of care and services are medically appropriate
• Evaluate member treatment before, during, and after services
• Perform prior authorization reviews according to regulatory guidelines and criteria
• Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
• Analyze behavioral health member data to improve quality and utilization
• Educate providers, members, and families about the behavioral health utilization process
• Interact with behavioral health providers regarding levels of care and services
• Engage medical directors and leadership to improve care quality and efficiency
• Formulate and present cases in staffing and integrated rounds
• Comply with policies and standards and perform other assigned duties

Utilization Review Clinician – Behavioral Health

• Perform comprehensive behavioral health and substance use evaluations
• Determine provisional diagnoses and discuss treatment recommendations with patients, families, and medical providers
• Coordinate level-of-care expectations with physicians, care teams, patient care units, and external agencies
• Conduct assessments remotely via telehealth and on-site at local hospitals and community sites
• Provide assessment services across pediatric, adolescent, adult, and geriatric populations as needed
• Perform insurance prior authorizations/pre-certifications and support intake for admitted patients
• Build and maintain relationships with referral sources across the assigned region through community outreach
• Monitor referral trends and conversion patterns to improve access and service responsiveness
• Resolve referral source concerns and complaints in partnership with leadership
• Maintain proficiency in legal and regulatory processes relevant to assessment and admission, including EMTALA and Mental Inquest Warrants
• Uphold HIPAA privacy and security requirements
• Participate in department meetings and complete required trainings and competencies
• Support continuous improvement and perform other duties as assigned

Clinician jobs in Kentucky

Utilization Review Clinician – Behavioral Health

Assessment Clinician