Utilization Review Clinician – Behavioral Health

Behavioral Health Services North Inc; City of Plattsburgh (NY); Vor Ort; USD 72.000 - 78.000; Vollzeit

Benefits dieser Stelle

Health insurance

Paid time off

Holiday pay

Training opportunities

Zusammenfassung

The Utilization Review Clinical Specialist (URCS) at Behavioral Health Services North Inc conducts clinical utilization review across programs, focusing on the CCBHC model. They evaluate medical necessity, level of care, service intensity, frequency, and duration to ensure services are clinically appropriate and aligned with individual needs.

The URCS provides clinical consultation to supervisors and treatment teams, supports quality improvement and compliance with OMH, OASAS, Medicaid

Qualifikationen

• Master's degree and current NY State license in Social Work, Mental Health Counseling, Psychology, Marriage and Family Therapy, or related behavioral health disciplines.
• Experience providing behavioral health services in an outpatient, community mental health, CCBHC, hospital, or integrated behavioral health setting.
• Demonstrated knowledge of behavioral health assessment, treatment planning, medical necessity, level-of-care determination, and clinical documentation.
• Strong understanding of clinical risk assessment and behavioral health service delivery.
• Ability to independently review complex clinical information and formulate clinically sound recommendations.

Aufgaben

• Conducts prospective, concurrent, retrospective, and continued-stay reviews to assess medical necessity, clinical appropriateness, level of care, service intensity, frequency, and duration.
• Completes required continued-need reviews within established timeframes and identifies underutilization, overutilization, and changes in clinical need.
• Reviews and recommends level-of-care changes based on clinical presentation, risk, functioning, engagement, and service utilization.
• Provides clinical consultation and recommendations to supervisors, program leadership, and treatment teams.
• Identifies barriers to engagement and collaborates with teams on outreach, re-engagement, care planning, and access to services.
• Reviews utilization across disciplines and levels of care to support care coordination, service bundling, appropriate service intensity, and continuity of care.

Kenntnisse

Clinical assessment

Treatment planning

Medical necessity

Level-of-care determination

Clinical documentation

Risk assessment

Care coordination

Ausbildung

Master's degree + NY State license in related behavioral health discipline

Jobbeschreibung

The Utilization Review Clinical Specialist (URCS) at Behavioral Health Services North Inc conducts clinical utilization review across programs, focusing on the CCBHC model. They evaluate medical necessity, level of care, service intensity, frequency, and duration to ensure services are clinically appropriate and aligned with individual needs.

The URCS provides clinical consultation to supervisors and treatment teams, supports quality improvement and compliance with OMH, OASAS, Medicaid