Clinician

Job not on LinkedIn

🔥 3 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $70.5k - $94.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 to determine medically appropriate level of care and length of stay • Evaluate the necessity, appropriateness, and efficiency of behavioral health medical services and procedures • Coordinate and assist with implementation of member care plans • Monitor and coordinate out-of-network and out-of-area services, including internal fee negotiations when appropriate • Coordinate with patients, families, physicians, hospitals, and external customers regarding care from diagnosis through outcome • Coordinate high-quality, cost-effective care across the continuum using clinical practice guidelines • Monitor behavioral health care activities and outcomes for appropriateness and effectiveness • Advocate for members and families across care sites to coordinate resource utilization and service evaluation • 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 to promote continuity and efficiency • Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs • Complete other assigned functions as requested by management

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred, or relevant experience in lieu of degree • Minimum of two (2) years of behavioral health clinical experience • Behavioral health experience preferably in a managed care setting • Active unrestricted NJ LCSW, LMFT, LPC, or RN license • Proficiency in personal computers and Windows-based software, including Microsoft Office products and Lotus Notes preferred • Knowledge of intranet and internet applications preferred • Working knowledge of case/care management principles preferred • Working knowledge of utilization management principles preferred • Basic knowledge of health care contracts and benefit eligibility requirements preferred • Knowledge of hospital structures and payment systems preferred • Analytical, interpersonal, client relationship, judgment, listening, planning/priority-setting, problem-solving, time-management, written/oral communication, and organizational skills • For field-based positions, 100% travel is required

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement • Meaningful work that directly improves lives • Mission-driven organization supporting expertise, collaboration, and growth