BH UM Clinician in Watertown, MA at Integrated Resources, Inc

Date Posted: 3/17/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Watertown, MA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    3/17/2021

Job Description


To provide behavioral health utilization review and care management in order to ensure timely and appropriate services for the membership while in Behavioral Health acute, diversionary, or outpatient levels of care and to ensure coordination of care. To facilitate coordination and integration of behavioral health, medical management, and case management services. KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME
(Optional) Conduct clinical precertification, concurrent and discharge reviews for behavioral health treatment requests. Evaluate clinical information to screen for medical necessity of behavioral health services and ensure members receive the most appropriate treatment based on their clinical presentation and needs. Consult with internal managers and physician advisors when it appears requests for services do not meet medical necessity criteria, and propose alternative plans of treatment. Work as a member of one of the following teams:

Access Line
  • Primary responsibility for outpatient and diversionary levels of care
  • Coordinate plans for additional treatment as needed

CBHI (Childrens Behavioral Health Initiative) Team
  • Primary responsibility for CBHI levels of care
  • Coordinate plans for additional treatment as needed

Concurrent Review Team
  • Primary responsibility for acute and post-acute levels of care
  • Coordinate discharge plans to ensure members step down from acute care to an appropriate setting, and coordinate plans for additional treatment as needed
Coordinate the delivery of services to members throughout the continuum of care and interface with providers as needed to ensure appropriate services are being provided. Consult with providers to assist members with transportation, employment and daily living needs as they relate to individualized behavioral health treatment plans. Provide information to providers and members regarding behavioral health benefits and treatment resources. Provide telephonic triage and crisis intervention to callers. Interact with others in a professional, respectful manner that facilitates the treatment process. Identify through proactive concurrent reviews high-risk/high cost complex members for internal case management, and make appropriate referrals. Collaborate closely with Integrated Care Management and Medical Management departments to ensure behavioral, medical and social care management interventions are integrated. Provide back up for peers, including other teams within the Behavioral Health department Identify opportunities for improvement and participate in development of action plans as needed Participate in clinical activities, initiatives and projects to achieve Client goals. Work collaboratively with other departments as appropriate. Adhere to all department and regulatory standards, and ensure all workflow processes are completed within required timeframes. This includes, but is not limited to, standards for documentation of clinical information and authorizations of care. For CBHI Team: Participate in external meetings with various stakeholders, and carry out network management activities throughout the state. All other duties as assigned. JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
EDUCATION: (Minimum education & certifications required)
  • Masters degree in behavioral health related discipline (social work, counseling psychology or related field, nursing)
  • Active unrestricted Massachusetts licensure to practice independently as behavioral health clinician (LICSW, LMHC, LMFT, RN, PhD, PsyD)

EXPERIENCE: (Years of experience)
  • Minimum of 2 years post-masters direct clinical experience; 3-5 years preferred
  • Experience with managed care and/or Medicaid a plus

SKILL REQUIREMENTS: (Include interpersonal skills)
  • Minimum of two years of experience in clinical settings providing direct client care.
  • Solid understanding of the continuum of behavioral health levels of care.
  • Excellent interpersonal and communication skills. Able to build relationships with and respond to internal and external stakeholders at a variety of levels. Able communicate effectively verbally and electronically.
  • Excellent time management skills. Able to set priorities and complete work within timeframes.
  • Ability to multitask, especially typing while simultaneously conducting utilization reviews.
  • Proficiency with Microsoft applications, including Excel and Word
  • Ability and willingness to work autonomously yet simultaneously interdependently on small to large teams.
  • High adaptability to an ever-changing managed care environment.
  • For CBHI Team: valid drivers license AND access to a vehicle in good working condition to travel to external meetings and network management meetings.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)
Fast paced office environment. Work requires ability to use independent judgment and discretion in making decisions which may impact the organization. Must utilize various sources of communication such as written, verbal and non-verbal communication to effectively impart information to others. Requires availability to work early morning and evening hours when necessary to meet deadlines.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Client is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.