Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical case/care management. Perform utilization management functions, including authorization determinations and care shaping.
Handle member calls, performing activities such as telephonic clinical assessment, determining appropriate level of care and services and answering benefit questions.
Perform utilization review functions with behavioral health providers, including care shaping and authorization determinations.
Responsible for utilization management activities with providers and/or member calls, depending on team.
Triage crisis calls, providing in-the-moment support and assisting with access to emergency services.
Use established protocols, as well as clinical judgment, to evaluate and problem solve during interactions with members and providers.
Document all calls and activities within a data management system and access multiple databases for benefit and workflow information.
Enhance clinical knowledge and skills by actively participating in all assigned training and staff meetings
Education/Experience: Master’s degree in behavioral health and 3+ years of behavioral health experience (at least 2 years must be post-Master's degree). Prior managed care experience preferred. Prior experience with multiple system applications and electronic data entry, including call center and/or health care databases preferred.
License/Certification: Unrestricted license as Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or Licensed Psychologist (PhD).
Job ID 1123196