Clinician

• Review clinical information and assess medical necessity under relevant guidelines and/or medical policies
• Ensure appropriate and consistent administration of plan benefits
• Handle complex cases requiring evaluation of multiple variables against guidelines
• Serve as a resource to lower-level clinicians and staff
• Collaborate with leadership on process improvement initiatives for utilization reviews and medical management
• Assess and apply medical policies and clinical guidelines within scope of licensure
• Conduct and potentially approve pre-certification, concurrent, retrospective, out-of-network, and appropriateness-of-treatment-setting reviews
• Process medical necessity denial determinations made by a Medical Director
• Develop and foster relationships with physicians, healthcare providers, and internal and external customers
• Refer complex or unclear reviews to higher-level nurses and/or Medical Directors
• Collaborate with leadership to enhance training and orientation materials
• Assist with process improvement initiatives
• Help train lower-level clinician staff
• Does not issue medical necessity non-certifications

Senior Medical Management Clinician

• Provide confidential individual behavioral health counseling through secure virtual video and/or telephone appointments
• Deliver brief, goal-focused, solution-oriented therapy
• Conduct clinical screenings, intake assessments, risk assessments, and establish individualized treatment goals
• Use evidence-based interventions, including CBT and, when appropriate, DBT
• Address performance anxiety, academic and athletic stress, anxiety, mild depressive symptoms, adjustment, injury recovery, interpersonal conflict, sleep, motivation, and stress management
• Monitor clinical progress and use outcome/progress measures
• Complete timely and accurate clinical documentation within 24 hours of each encounter
• Identify needs outside program scope and initiate referrals for crisis services, higher levels of care, substance use, eating disorders, or specialized behavioral health needs
• Follow university and program protocols for safety concerns, mandated reporting, emergencies, and referrals
• Develop transition and discharge plans
• Provide warm handoffs and referrals to Longwood Counseling Services, community providers, or other resources
• Maintain confidentiality and comply with HIPAA and FERPA-related requirements
• Coordinate with university personnel only with appropriate consent and applicable privacy standards
• Develop familiarity with assigned athletic teams’ culture, schedules, and stressors
• Participate in mental health education, seminars, workshops, or masterclasses
• Support utilization tracking and de-identified aggregate program reporting
• Participate in program evaluation and provide feedback on student-athlete needs, referral patterns, and program improvements

Licensed Behavioral Health Clinician

• Facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation
• Collect and assess patient information to develop comprehensive, individualized care management plans
• Promote appropriate utilization and cost-effective care and services
• Link clients with appropriate providers and resources across health and human services and care settings
• Coordinate with clients, payers, primary care providers, and other service-delivery professionals
• Maintain client privacy, confidentiality, health, and safety while adhering to ethical, legal, accreditation, certification, and regulatory standards
• Answer medical or contract-interpretation questions referred by other departments, physicians, and providers
• Assist employers and agents with healthcare-resource and procedure questions
• Practice effective written and verbal communication
• Utilize and promote evidence-based tools
• Utilize lean methodologies for continuous improvement
• Meet department and company performance and attendance expectations
• Follow PacificSource privacy policy and HIPAA confidentiality and security requirements
• Perform other duties as assigned
• Travel approximately 5% of the time

Care Management Clinician

• Facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management and service facilitation
• Collect and assess patient information to develop comprehensive, individualized care management plans
• Promote appropriate utilization and cost-effective care and services
• Link clients with appropriate providers and resources across health and human services and care settings
• Coordinate communication among clients, payers, primary care providers and other service professionals
• Maintain client privacy, confidentiality, health and safety in accordance with ethical, legal, accreditation, certification and regulatory standards
• Answer medical or contract interpretation questions referred from other departments, physicians and providers
• Assist employers and agents with healthcare resource and procedure questions
• Use evidence-based tools and lean methodologies for continuous improvement
• Meet department and company performance and attendance expectations
• Follow PacificSource privacy policy and HIPAA requirements
• Perform other duties as assigned
• Work in a general office setting and travel approximately 5% of the time