<p>The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.</p> <p>Qualifications you'll bring:</p> <p>Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required New York State license required Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required. Willingness and ability to obtain equivalent license in Vermont Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related Utilization or Case Management experience in a managed care organization is preferred Knowledgeable with diagnosis and procedural coding preferred Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines. Ability to make independent decisions regarding resource utilization, and quality of care. Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction</p> <p>Your key responsibilities:</p> <p>Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont. Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules. Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs. Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains. Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases. Maintain accurate and timely documentation in compliance with regulatory standards. Participate in quality improvement initiatives and team meetings. Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.</p> <p>Where you'll be: Virtual in NYS</p>