Clinician

• Performs reviews of member's care and health status of ABA services
• Monitors clinical effectiveness and efficiency of member's care
• Evaluates member’s care and health status before, during, and after provision of ABA services
• Analyzes BH member data to improve quality and appropriate utilization of services
• Provides education to members and their families regarding ABA and BH utilization process

Utilization Review Clinician managing ABA services for health management organization

Utilization Review Clinician – ABA

Utilization Review Clinician managing ABA services for Centene's Medical Management team. Evaluating member care and ensuring medical appropriateness of behavioral health services and treatment.

• Provide timely crisis assessment and intervention via phone, video, or in person
• Conduct Zero Suicide screenings and risk evaluations
• Make clinically sound decisions to stabilize individuals and refer to appropriate services
• Coordinate care with internal teams and external community partners
• Deliver culturally responsive, trauma-informed care
• Document services accurately and maintain compliance with agency and state standards
• Participate in supervision and collaborate with multidisciplinary teams
• Regional travel required; hybrid work environment with office-based shifts required

Mobile Crisis Clinician providing mental health support in Jefferson County

Mobile Crisis Clinician – Weekend Overnights

Mobile Crisis Clinician providing mental health crisis intervention to individuals in behavioral health distress. Working part-time on weekends and collaborating with a skilled team in Jefferson County.

• Provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management
• Develops, implements, and monitors clinical documentation incorporated into clinical guidelines, policies, and/or procedures
• Drafts clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures
• Monitors and organizes the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures
• Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures
• Oversees the modification or creation of member and provider letters
• Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes
• Measures and evaluates effectiveness as it relates to current workflows and processes
• Researches and identifies industry best practices to contribute to the development of guidelines, policies, and procedures
• Develops and maintains documentation necessary to support consistent, operationally sound processes

Clinician Specialist providing clinical support for 28 million members in Medical Management

Clinician Specialist

Clinician Specialist providing clinical and operational support for utilization management in a national organization. Seeking a candidate with expertise in developing clinical policies and operational efficiency.

• Collaborate closely with physicians, nurses, social workers, and a wide range of medical and non-medical professionals
• Assess the member’s specific health plan benefits
• Provide utilization management (UM) services promoting quality, cost-effective outcomes
• Facilitate outstanding member care using fiscally responsible strategies
• Perform concurrent review of members admitted to inpatient facilities

Utilization Management Clinician supporting PacificSource healthcare services

Utilization Management Clinician – Tuesday, Saturday

Utilization Management Clinician responsible for assessing healthcare benefits and collaborating with medical professionals at PacificSource. Ensures quality and cost-effective outcomes for member populations through effective healthcare service utilization.

• Provide trauma-informed and person-centered crisis intervention via phone
• Assess caller needs, screen for safety, and connect to appropriate services or resources
• Collaborate with internal and external providers to ensure coordinated care
• Maintain accurate and timely documentation in compliance with agency standards
• Participate in supervision and team meetings to support continuous improvement

Crisis Line Clinician providing support for individuals in crisis via phone

Crisis Line Clinician – Weekend Nights

Crisis Line Clinician providing trauma-informed support for individuals in crisis. Working remotely to connect with rural communities and provide vital resources and intervention.

Mobile Crisis Clinician providing behavioral health crisis intervention

Mobile Crisis Clinician – Weekends

Mobile Crisis Clinician providing behavioral health crisis intervention on weekends for individuals in distress. Collaborating with a skilled team and delivering timely assessments in various settings.

• Conduct online “Video Visits” with health plan members, working in a private space with adequate internet connection
• Provide 40 hours of availability weekly, consistently providing 320+ capacity units per month
• Execute a strong visit completion rate, consistently pacing 220+ completed visits per month
• Maintain training, affiliation, and compliance with Video Visit requirements (regular training required)
• Engage with regular manager, team and clinical meetings
• Be accountable to Signify Health operational, clinical, and member experience key performance indicators and metrics
• Maintain active state licenses in coverage areas

Full-time Physician conducting Video Visits for health plan members

Virtual Clinician – Home Evaluations, Full Time

Full-time Physician conducting online Video Visits for health plan members, working remotely while engaging with health plan members primarily online.

• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and NCQA standards
• Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
• Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
• Communicates with members, providers, facilities, and other departments regarding appeals requests
• Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
• Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests
• Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
• Performs other duties as assigned
• Complies with all policies and standards

Clinical Review Clinician performing appeals reviews in behavioral health for Centene.

Clinical Review Clinician – Appeals, Behavioral Health

Clinical Review Clinician performing behavioral health appeals reviews for Centene's Medical Management team. Responsible for ensuring compliance with clinical data, policies, and NCQA standards.

Crisis Line Clinician providing support for individuals in crisis situations

Crisis Line Clinician – Overnights/Weekends

Crisis Line Clinician with Compass Health Network providing trauma-informed support to individuals in crisis. Conduct assessments, ensure safety, and connect callers to needed resources.

Crisis Line Clinician supporting individuals during crisis through compassionate intervention

Crisis Line Clinician – Every Other Weekend Overnights

Crisis Line Clinician at Compass Health Network providing support during crisis calls. Collaborating with service providers and offering intervention for individuals seeking help.

Clinician jobs in Montana

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