Clinician

• Perform clinical reviews and assess care related to mental health and substance abuse
• Monitor and determine whether levels of care and services are medically appropriate
• Evaluate member treatment before, during, and after services
• Perform prior authorization reviews in accordance with regulatory guidelines and criteria
• Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
• Analyze behavioral health member data to improve quality and appropriate utilization of services
• Educate providers, members, and families about the behavioral health utilization process
• Interact with behavioral health providers regarding level of care and services
• Engage with medical directors and leadership to improve care quality and efficiency
• Formulate and present cases in staffing and integrated rounds
• Comply with all policies and standards
• Perform other duties as assigned

Behavioral health utilization review clinician assessing mental health care for Centene members

Utilization Review Clinician – Behavioral Health

Behavioral health utilization review clinician assessing mental health and substance abuse care for Centene members. Performing authorizations, concurrent reviews, and discharge planning.

• Provides integrated EAP services including intake and assessment, support, triage, referral, clinical case management, and crisis management
• Provides counseling services in a responsive, efficient, ethical, and professional manner
• Maintains client confidentiality in accordance with ethical standards
• Complies with applicable ethical, therapeutic, and legal standards, as well as organizational policies, procedures, and laws
• Refers clients to appropriate resources and maintains thorough clinical documentation in the electronic system
• Conducts assessments for issues such as substance abuse, mental health, and family problems that may affect workplace performance
• Performs initial assessments, crisis intervention, information and referral, and counseling services
• Conducts follow-up calls with clients as needed
• Performs additional duties as determined by the clinical management team
• Provides training, leads and participates in orientation sessions
• Develops and executes strategic activities for the organization

Consejero EAP bilingüe apoyando la salud mental de clientes en Texas para Workplace Options

Qualified EAP Clinician

Consejero EAP bilingüe para Workplace Options, proveedor global de apoyo emocional, terapia y servicios de bienestar. Realizando evaluaciones, asesoramiento, gestión de casos y crisis para clientes en Texas.

• Working with long-term care facilities in a designated territory to assist with wound assessments and treatment decisions
• Monitoring proper application and utilization of wound care products
• Understanding Medicare documentation and reimbursement guidelines
• Educating facility staff on documentation that meets federal and state requirements
• Ordering wound care products through our internal system “FastCare” for the residents to receive their products
• Supporting facilities wound care programs by assisting with tracking, documentation, and understanding of the wound care products coverage guidelines

Licensed nurse or therapist supporting wound care assessments and treatment

Certified Wound Care Clinician, Nurse

Licensed nurse or therapist working with long-term care facilities for wound assessments and treatment decisions. Provides education and support to facility staff while fulfilling documentation requirements.

• Conduct intake interviews and assess client.
• Prepare goal-oriented psychosocial diagnostic assessments, service plans and progress reports.
• Provide case consultations, one-to-one counseling for clients, and/or crisis intervention.
• Maintain therapeutic services within National EMR and funding source guidelines.
• Develop and implement client tracking and status reports for monthly review/audit of clinical department.
• Provide data to support staff on admission/discharge of clients for them to maintain the permanent National EMR Census.
• Monitor and assist caseworkers and case aides in client supervision and milieu activities.
• Participate in or facilitate primary therapeutic/psycho educational groups or activities.
• Interview and complete preliminary service plan for each assigned client within 72 business hours.
• Participate in weekly scheduled case staffing with the treatment team to review clients' progress and compliance.
• Review client files to ensure proper documentation of therapeutic plan/services.
• Obtain and maintain working knowledge of State Licensing Standards and funding source guidelines.
• Attend and participate in twenty (20) hours of continuing education a year to maintain certifications dependent on current licensure.
• Other duties as assigned.

PRN Mental Health Clinician supporting emergency response teams and clients

Mental Health Clinician

PRN Mental Health Clinician supporting mental health needs of clients in emergency situations. Conducting assessments, providing counseling, and tracking client progress as part of an all-hazards response team.

• 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 National Committee for Quality Assurance (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 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 in Medical Management reviewing appeals for health services

Clinical Review Clinician – Appeals

Clinical Review Clinician managing medical necessity reviews in the appeals process for a national health services organization. Work includes collaborating with medical directors and ensuring compliance with healthcare standards.

• Provide outpatient services primarily through play therapy and DBT-C groups.
• Utilize Dialectical Behavior Therapy as a foundation for treatment following play therapy.
• Engage in psychoeducation, skills training, experiential exercises, and recovery concepts to facilitate long-term healing.
• Maximize client’s learning and practice of invaluable life skills.

Registered Children's Play Therapist providing outpatient services at Ethos Wellness.

Children's Services Clinician

Registered Children's Play Therapist providing outpatient services and utilizing DBT for long-term healing at Ethos Wellness. Engage in psychoeducation, skills training, and experiential exercises.

Clinician jobs in Texas