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Behavioral Health Utilization Management Clinician - Fully remote. The Behavioral Health Utilization Management Clinician is responsible for conducting utilization and quality management activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures.
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Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review, quality assurance, discharge planning. Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease.
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Identifies potentially catastrophic and high-risk cases for case management referral. Previous Quality Management liaison experience with hospitals and other large volume providers to address cost.
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The position responsibilities include the management of medical costs through timely prospective, concurrent, and retrospective review activities. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.
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About NYC Health + Hospitals. Maintains an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital Social Worker discharge planning staff.
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Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk CORE and HARP members. Superior Technical Computer skills (Microsoft Office, Care Connect, Teams Video Application.
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LCSW, LMSW, or LMHC. Current valid unrestricted NY State License. MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Pharmacy, Psyckes, E-Paces, LOCADTR, InterQual, Guiding Principles, HCS (UAS) MAPP, improvement, community health education, facility/provider relations and marketing activities. Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox.
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Psychiatric Hospital Inpatient and/or Outpatient setting preferred) Enlist existing provider network in promoting first episode psychosis treatment. Performs telephonic review for inpatient and outpatient services using InterQual & LOCADTR.
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