Responsibilities:

• Assess patient's behavioral health clinical need and ensure appropriateness of inpatient stay
• Evaluate necessity and efficiency of medical services provided
• Coordinate and assist in implementing care plans for members
• Monitor and coordinate services rendered outside of the network
• Advocate for members among various sites to coordinate resource utilization
• Encourage member participation in case/disease management programs
• Document accurately based on standards of practice and organization policies
• Interact and communicate with multidisciplinary teams for continuity of care
• Evaluate care, analyze variances, and participate in quality improvement programs
• Complete other assigned functions as requested by management

Education Qualification:

• Master's degree in a behavioral health related field or Nursing degree
• Minimum of two (2) years of behavioral health clinical experience
• Behavioral health experience in a managed care setting preferred

Required Skills:

• Active Unrestricted NJ LCSW, LMFT, LPC, or RN License Required
• Applied Behavior Analysis Certification preferred
• Proficiency in personal computers and MS Office products
• Knowledge of case/care management principles
• Understanding of utilization management principles
• Basic knowledge of health care contracts and benefit eligibility requirements
• Familiarity with hospital structures and payment systems