What are the responsibilities and job description for the Behavioral Health - Behavioral Health Clinical Specialist (LPC/LCSW) position at CommunityCare?
JOB SUMMARY :
The Behavioral Health Clinical Specialist (therapist) is an essential part of our behavioral health team and organization. This licensed behavioral health clinician will be instrumental in ensuring the appropriate utilization of behavioral health services for our members while upholding the highest standards of care and efficiency. This clinician will be responsible for clinical review and assessment of care for mental health and substance abuse services for the health plan. As well as monitoring and making level of care and service determinations for mental health and substance abuse requests. They will also provide support to members and front-line staff for urgent clinical matters.
KEY RESPONSIBILITIES :
- Conduct utilization management activities (i.e. initial and concurrent clinical reviews) assess, certify, and refer members for behavioral health services and conducts ongoing dialogue with providers related to appropriate managed care handling of the case needs.
- Communicate with members, providers, and internal stakeholders to gather necessary information for utilization review decisions and ensure timely authorization of services.
- Monitor members' progress throughout the course of treatment, conducting ongoing reviews to assess effectiveness and make recommendations for adjustments as needed.
- Document all utilization review activities accurately and thoroughly, maintaining compliance with regulatory requirements and health insurance company policies.
- Conducts provider clinical chart audits and provider trainings as needed.
- Participate in interdisciplinary team meetings, case conferences, and quality improvement initiatives to enhance the delivery of behavioral health services and member outcomes.
- Stay informed about changes in healthcare regulations, clinical best practices, and industry trends to support informed decision-making and continuous improvement efforts.
- Uphold the highest standards of ethics, professionalism, and confidentiality in all interactions with members, providers, and colleagues.
- Performs other job duties as assigned.
QUALIFICATIONS :
EDUCATION / EXPERIENCE :
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
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