Behavioral Health Clinician

Behavioral Health Clinician/Psych Nurse needed for a REMOTEcontract opportunity with Yoh’s insurance client located in Philadelphia, PA. The Behavioral Health Care Management Coordinator reviews medical and treatment records to assess a member’s behavioral health condition and determine medical necessity for services using established criteria. Collaborates with providers to obtain additional information when needed, independently authorizes medically necessary services, and refers cases that do not meet criteria to the Medical Director for further review. Maintains compliance with regulatory requirements, serves as a patient advocate, and helps members navigate the behavioral health care system.**Candidate must reside in the tri-state area (PA, DE, NJ)** Candidate must have an active RN, LSW, LCSW, LPC or LMFT to practice in the state of PA Schedule: Monday-Friday, 730a-4p or 8a-430pDuration: 10/12-1/07 with possible extension or direct placementPay: $32-45/hr, DOE What You’ll Be Doing:Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination. Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.Utilizes the behavioral health criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if neededIdentifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.Performs early identification of members to evaluate discharge planning needs.Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.Reports potential utilization issues or trends to designated manager and recommendations for improvement.Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.Appropriately refers cases to Case and Disease Management.Ensures request is covered within the member’s benefit plan.Ensures utilization decisions are compliant with state, federal and accreditation regulations.Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.Ensures that all key functions are documented via Care Management and Coordination Policy.Maintains the integrity of the system information by timely, accurate data entry.What You Need to Bring to the Table:LCSW or LMFT or LPC or Active PA Licensed RN3+ years of Behavioral Health clinical experience in a hospital or other health care setting. Prior Behavioral Health utilization management experience is desirable.Medical management/precertification experience preferred.Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs with the ability to learn new systems as technology advances.What’s In It For You?Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.Weekends and holidays offDirect deposit & weekly epayrollAPPLY NOW!Recruiter: Laura MopasEstimated Min Rate: $30.00Estimated Max Rate: $45.00What’s In It for You?We welcome you to be a part of the largest and legendary global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities and gain access to this exclusive opportunity available to you. Benefit eligibility is in accordance with applicable laws and client requirements. Benefits include:Medical, Prescription, Dental & Vision Benefits (for employees working 20+ hours per week)Health Savings Account (HSA) (for employees working 20+ hours per week)Life & Disability Insurance (for employees working 20+ hours per week)MetLife Voluntary BenefitsEmployee Assistance Program (EAP)401K Retirement Savings PlanDirect Deposit & weekly epayrollReferral Bonus ProgramsCertification and training opportunitiesNote: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.Visit to contact us if you are an individual with a disability and require accommodation in the application process.For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.By applying and submitting your resume, you authorize Yoh to review and reformat your resume to meet Yoh’s hiring clients’ preferences. To learn more about Yoh’s privacy practices, please see our Candidate Privacy Notice: Safe During Your Job SearchFraudulent recruiting communications have become increasingly common. Emails from Yoh recruiters will only come from an @yoh.com email address. Yoh will never ask candidates to pay fees, purchase equipment, send gift cards, or transfer funds as part of the recruiting or hiring process. If you receive a communication that appears suspicious or requests payment, contact Yoh directly before responding or sharing personal information.Reference: BH-400456