Behavioral Health, Professional, Behavioral Health (UM for Autism Services) #907
Status: Full-time, Exempt
The Behavioral Health (UM for Autism Spectrum Services) makes triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD). The individual will follow members for mental health, substance use and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care. The individual will review all requests for inpatient services in view of the Appropriate BH and MVP standards, such as Interqual and LOCADTR guidelines, assuring that appropriate follow up of outpatient services occur.The position will provide case management/ care coordination for members to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual’s behavioral health needs. The individual will review requests for all outpatient care plans for both mental health or substance services, using MVP’s Utilization Management programs for entering and tracking cases, correspondence, and documentation. In addition, the individual will conduct retrospective review of inpatient/outpatient cases and reviews as needed, with supervisors or medical directors. Individuals will share after hours and weekend on-call responsibilities. Site visits to providers or to facilities to attend team meetings to assist in developing relationships and safe, effective alternative service settings may be required. Performs other duties and special projects as assigned.
This position can be worked as a hybrid position (combination of work from home and in the office), worked remotely from a New York based residence or worked full-time onsite in the Schenectady or Rochester MVP office.
Master’s prepared mental health clinician (LMSW, LCSW,LMHC), or licensed Registered Nurse (RN).
New York State licensure required with previous mental health or substance abuse experience.
Board Certified Behavior Analyst (BCBA) preferred, but not required.
Minimum of 3 years of clinical mental health or substance use experience required, with at least 2 years being ASD related.
UM or Case Management experience in a managed care organization is preferred.
Knowledgeable with diagnosis and procedural coding, Interqual and ASAM guidelines, psychiatric medication management, hospital case management, and related mental health and substance abuse treatment.
- Capable of independent thinking with excellent problem- solving skills.
- Strong interpersonal, communication and computer skills with the ability to work in a team setting.
Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
- Ability to work in an energetic team environment.
Experience with situations requiring strict adherence to confidentiality.
Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.
Ability to make independent decisions regarding resource utilization, and quality of care.
- Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access.
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at firstname.lastname@example.org
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