[Remote] BH Clinician (Case Manager)-REMOTE

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health and has been a leader in health solutions for over 90 years. The BH Clinician (Case Manager) is responsible for performing behavioral health duties, ensuring appropriate levels of care, and coordinating care management for members.ResponsibilitiesAssesses patient's behavioral health clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stayEvaluates the necessity, appropriateness and efficiency of behavioral health medical services and procedures providedCoordinates and assists in implementation of plan for membersMonitors and coordinates services rendered outside of the network, as well as outside the local area, and coordinates internally for negotiation of fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcomeCoordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of careMonitors patient's behavioral health medical care activities, regardless of the site of service, and outcomes for appropriateness and effectivenessAdvocates for the member/family among various sites to coordinate resource utilization and evaluation of services providedEncourages member participation and compliance in the behavioral health case/disease management program effortsDocuments accurately and comprehensively based on the standards of practice and current organization policiesInteracts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of careUnderstands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomesEvaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomesCompletes other assigned functions as requested by managementSkillsBachelor degree preferred or relevant experience in lieu of degreeRequires a minimum of two (2) years behavioral health clinical experienceActive Unrestricted NJ LCSW, LMFT, LPC or RN LicenseBehavioral health experience, preferably in a managed care setting, strongly preferredBi-lingual skills preferredPrefers 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; prefers knowledge in the use of intranet and internet applicationsPrefers working knowledge of case/care management principlesPrefers working knowledge of principles of utilization managementPrefers basic knowledge of health care contracts and benefit eligibility requirementsPrefers knowledge of hospital structures and payment systemsBenefitsComprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition ReimbursementCompany OverviewHorizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.