Clinician, CCR

• Clinical Review & Medical Necessity Determination
  • Conduct clinical reviews across all levels of behavioral health care and apply medical necessity criteria to treatment decisions
  • Utilize clinical judgment, evidence-based practices, and peer review processes to recommend appropriate levels of care
• Care Coordination & Member Support
  • Collaborate with members, families, providers, and internal teams to coordinate care and ensure access to appropriate services and resources
  • Support discharge planning and continuity of care, including referrals, follow-ups, and connection to community or outpatient services
•  Documentation, Compliance & Operational Excellence
  • Maintain accurate clinical documentation and adhere to health plan requirements, regulatory standards, and utilization management processes
  • Contribute to quality outcomes by managing caseloads, participating in clinical rounds, and supporting efficient service delivery within established guidelines

Who You Are

• Required Qualifications
  • Has a current, unrestricted license issued by a state or territory of the United States to practice independently as a clinical social worker, marriage and family therapist, professional counselor, clinical psychologist, or registered nurse in the state in which the business operation is located and/or other states as required by law, regulation, or contract. 
  • Minimum of two years of direct clinical care experience with patients in facility based and/or outpatient psychiatric or chemical dependency treatment.
  • Excellent verbal and written communication and interpersonal skills, strong computer and keyboarding skills including the ability to document while simultaneously taking information over the phone.
  • Ability to comprehend medical policy and criteria to clearly articulate health information.
  • Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen. 

Living our Values:

• • Serving everyone with compassion and leading with empathy.
  • Stepping up and creating value by taking charge and acting when there is an opportunity.
  • Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
  • Nurturing growth and belonging by respecting and celebrating everyone for who they are.

Competencies:

• • Self-motivated with excellent organizational skills.
  • Ability to multitask and manage multiple priorities in a fast-paced, changing environment.
  • Ability to work independently to meet caseload requirements.
  • Ability to work within a collaborative, team-oriented environment.
  • Ability to remain resilient and optimistic in the face of problems and challenges.
     

Working Conditions:

• • High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting) required.
  • Frequent use of computer and phone systems
  • Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations.
  • Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.
  • A quiet workspace with minimal background noise for calls.
  • This role requires working from a fixed, designated workspace in your home and does not allow flexibility in work locations even within the home.
  • A hardwired internet connection is required along with ability to sit for extended periods using company-issued wired headsets and desktop equipment. 

We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.