Job Type: Full time (Office based – some travel as needed)
Position Summary: Provides utilization management activities for all levels of behavioral health care including crisis care, residential, partial care, intensive outpatient and outpatient, PACT, and substance use and referral to inpatient/other levels of care as appropriate.
Demonstrates clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters.
Performs electronic, paper and telephonic care review and authorization determinations for prospective, concurrent and discharge review with mental health and substance use treatment cases.
Determines appropriate level of care related to mental health and substance use treatment for consumer based on medical necessity level of care criteria.
Utilizes best practice standards to render medical necessity determinations.
Adheres to departmental and state guidelines and clinical best practice standards to facilitate a desired outcome.
Consults with Catholic Charities Physician Advisor when request for services do not meet medical necessity criteria.
Interacts with Physician Advisor to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases.
Provides telephone triage and crisis intervention to callers and when necessary, assist with ensuring clients/consumers have access to local services and resources.
Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
Provides case consultations for complex cases and situations.
Collaborates with clinicians to assess physical, behavioral, social and transitional care needs and assists as needed to develop person centered, integrated, recovery oriented service plans to meet the needs of the consumer.
Monitors staff for appropriateness and congruence of application of medical necessity criteria during utilization review process. Provides training to staff as needed.
Assists in the recommendation of client/consumers care to designated collaborating agencies and monitors care and length of stay.
Monitors daily, weekly and monthly utilization reports to ensure that targets are met.
Recognizes quality of care issues and reports them appropriately through internal/external processes under the direction of the Director of compliance.
Makes recommendation of programs and/or systems that create improved outcomes and timeliness of the utilization management process.
Participates in on-going continuing education as required.
Participates in special committees or projects for program development as assigned.
Adheres to policies and procedures for Utilization Management activities as well as screening, triage and referral activities, including timeliness of activities/services and accuracy of documentation.
Documents all determinations, notifications, intervention and telephone encounters in the appropriate system and in accordance with established documentation standards and regulatory guidelines.
Master's degree from accredited university.
Current, unrestricted license to practice independently as a Licensed Clinical Social Worker (LCSW) in the state of NJ.
Minimum of five (5) year post-licensure experience in direct clinical care with high risk/complex consumers in facility based and/or outpatient psychiatric or substance use treatment facilities.
Experience, knowledge of: Health Homes, supported housing, supported employment programs, vocational rehabilitation, community integration programs, peer services, mobile crisis, PACT team and other community services.
Previous experience in Utilization management or Case Management
Extensive clinical knowledge base
Strong knowledge about the impact of mental health, substance use disorders and psychosocial stressors on the physical health conditions.
Excellent verbal and written communication skills and interpersonal skills are essential
Strong computer skills including the ability to document while simultaneously taking information over the phone or in person.
Catholic Charities, Diocese of Trenton, is the 15th largest Catholic Charities agency in the U.S. and 10th largest nonprofit within the state of New Jersey with an annual operating revenue of more than $40 million. Annually, a staff of 600 provides more than 100,000 people in Burlington, Mercer, Monmouth and Ocean counties with support related to housing, food, mental health, specialized children’...s services, addiction treatment and domestic violence services. A private nonprofit recognized by the Chronicle of Philanthropy as one of the most fiscally efficient in the country, the organization uses less than 10 percent of our revenue for administrative costs. Catholic Charities is a faith-inspired organization and Affirmative Action/Equal Opportunity Employer, fostering a diverse and inclusive environment for staff as well as for people seeking assistance.
Catholic Charities, Diocese of Trenton, is a great place to work! We are mission driven, family friendly, and passionate about service to our communities. We offer a wide variety of exciting career opportunities in the following areas: Direct Care, Clinical, Fundraising & Development, Human Resources, I.T., Finance, Communications & Marketing, Nursing, Residential Care, and Government Relations. When you join us, you can expect a true focus on work-life balance, competitive salaries, comprehensive benefit programs, and an environment that promotes inclusion. To learn more about the agency, please visit our website at : www.catholiccharitiestrenton.org.