Behavioral Health Utilization Management Clinician, Consultant (Lead) Position Available In Plymouth, Massachusetts

Job Description:

Your Role The Behavioral Health (BH) Utilization Management (UM)team performs prospective, concurrent, retrospective utilizationreviews and first level determinations for members using BSCevidenced based guidelines, policies, and nationally recognizedclinical criteria across multiple lines of business. The BehavioralHealth Utilization Management, Consultant (Lead), will report tothe Manager of Behavioral Health Utilization Management (BH UM). Inthis role you will support the clinicians with daily operations,provide coaching, and serve as the subject matter expert for the BHUM team as they conduct clinical reviews of mental health andsubstance use authorization requests at various levels of care formedical necessity. Your Work In this role, you will: Facilitatecommunication between leadership, Medical Directors, andnon-clinical leads to address line staff questions and issues;escalate matters to management with recommendations or consultationas needed Lead onboarding/training of incoming staff, provideproactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilizationmanagement through team and departmental expansion as needed Act assubject matter expert to review and evaluate the effectiveness ofoperational workflows to identify problems and developimprovements, modifications, and enhancements Develop and evaluatetools and materials that enhance operating efficiency, accuracy,and technical skill levels of unit staff Assist with auditreadiness in collaboration with internal BSC partners Performadvanced or complicated prior authorization and concurrentutilization reviews and first level determinations for membersusing non-profit association guidelines ensure discharge (DC)planning at levels of care appropriate for the members needs andacuity; prepare and present cases to Medical Director (MD) foroversight and necessity determination Identify process and controlimprovement opportunities and provide recommendations that helpimprove the effectiveness, efficiency and/or economic value of acontrol or process Provide guidance, coaching and training oninternal behavioral health utilization management processes toother employees across the company as appropriate Lead, manage, andexecute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaborationof team members Support team through consistent and successfulcaseload management and workload to achieve team goals, regulatorytimelines, and accreditation standards Your Knowledge andExperience Current unrestricted CA license (LCSW, LMFT, LPCC,PhD/PsyD or RN with Behavioral Health experience) required Advanceddegree commensurate with field is preferred Requires at least seven(7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadershiptraining is preferred Five (5) years conducting Behavioral HealthUtilization Management for a health insurance plan or managed careenvironment preferred Deep knowledge of Behavioral HealthUtilization Management including ability to apply and interpretadmission and continued stay clinical against nonprofit associationguidelines Familiarity with medical terminology, diagnostic terms,and treatment modalities including ability to comprehendpsychiatric evaluations, clinical notes, and lab results Proficientwith Microsoft Excel, Outlook, Word, Power Point, and the abilityto learn and utilize multiple systems/databases Excellentanalytical, communication skills, written skills, time management,and organizational skills Possess outstanding interpersonal,organizational, and communication skills, positive attitude, andhigh level of initiative Ability to identify problems and workstowards problem resolution independently, seeking guidance asneeded