Clinician II

Job not on LinkedIn

🔥 4 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $79.1k - $105.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 13%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Assess patients' behavioral health clinical needs against established guidelines and standards to determine medically appropriate level of care and length of stay. • Evaluate the necessity, appropriateness, and efficiency of behavioral health medical services and procedures. • Develop, coordinate, and assist with implementation of individualized member care plans and identify barriers to self-management and wellness. • Apply Milliman Care Guidelines (MCG) and American Association of Addiction Medicine (ASAM) criteria. • Monitor and coordinate out-of-network and out-of-area services and negotiate fees when appropriate. • Coordinate with patients, families, physicians, hospitals, and external customers regarding care appropriateness from diagnosis through outcome. • Coordinate high-quality, cost-effective care across the continuum, including transitional care. • Monitor behavioral health care activities and outcomes for appropriateness and effectiveness. • Advocate for members and families across care settings. • Encourage member participation and compliance in behavioral health case/disease management programs. • Document accurately and comprehensively according to practice standards and organizational policies. • Communicate with multidisciplinary teams telephonically and/or in person. • Evaluate care, analyze variances, and participate in quality improvement programs. • Mentor and train new BH Clinicians and other staff. • Serve as an escalation point for complex cases and issues. • Coordinate clinical process improvements with the team supervisor. • Work independently on special projects and complex cases. • Recommend workflow and process improvements. • Execute UAT test cases end to end. • Work one holiday shift per year. • For Navigation roles, facilitate responses to care gaps and high-risk members, collaborate with providers, and present clinical cases during external audits. • For BH Clinical Advocate roles, conduct member outreach, apply clinical expertise, use Motivational Interviewing, explain ASO benefits, and educate members to navigate the healthcare system. • Work an 8- or 10-hour Monday–Friday schedule with operating hours varying from 8AM–8PM EST. • Travel to office locations as required for BH Clinical Advocate roles.

🎯 Requirements

• High School Diploma/GED required. • Bachelor degree in a behavioral health related field or Nursing degree preferred or relevant experience in lieu of degree. • Prefers a masters in a behavioral health related field or Nursing degree. • Requires a minimum of 2 years behavioral health clinical experience. • Requires 1 year behavioral health experience in a managed care setting or health insurance industry. • Active Unrestricted NJ LCSW, LMFT, LPC, LBA or RN License Required. • CCM Certification preferred for BH Clinical Advocate roles. • 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 preferred. • Knowledge in the use of intranet and internet applications preferred. • Working knowledge of case/care management principles preferred. • Working knowledge of principles of utilization management preferred. • Basic knowledge of health care contracts and benefit eligibility requirements preferred. • Knowledge of hospital structures and payment systems preferred. • Bi-lingual proficiency preferred for BH Clinical Advocate roles. • For field based positions, travel required 100%.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement