Behavioral Health Clinical Auditor LPC, LCSW, LMSW

Job Description
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Local travel up to 50% just Kenner/Baton Rouge of Louisiana.

Standard business hours Monday-Friday.

No nights, no weekends and no holidays.

Fundamental Components
Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. - Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care: - Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits - Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes - Identifies and escalates quality of care issues through established channels -Ability to speak to medical and behavioral health professionals to influence appropriate member care. - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health -Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. -Helps member actively and knowledgably participate with their provider in healthcare decision-making -Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs. Monitoring, Evaluation and Documentation of Care: -In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals -Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Background Experience
3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Experience working with Medicaid Behavioral Health as a provider or with its clients.
Program creation & facilitation preferred
Crisis intervention skills preferred
Managed care/utilization review experience preferred
Case management and discharge planning experience preferred
Experience with LVH preferred

EDUCATION
Minimum of a Master's degree in Behavioral/Mental Health or related field

LICENSE
The applicants need to be licensed as an LPC, LCSW, or LMSW active in the state of Louisiana.

Education
Master's degree

Percent of Travel Required
25 - 50%