Clinician, Clinical Operations - SUD

• Care Management, Utilization Management, & Clinical Review
  • Conducts comprehensive clinical assessments, utilization reviews, care planning, and care coordination activities to support appropriate levels of care, recovery-focused treatment, and positive member outcomes
• Member, Provider & Community Engagement
  • Partners with members, providers, health plans, and community resources to promote treatment engagement, address barriers to care, and support recovery through education, advocacy, and coordinated interventions.
• Compliance, Documentation & Professional Development
  • Ensures regulatory compliance through accurate clinical documentation, effective use of care management systems, participation in quality improvement initiatives, and ongoing development of clinical and industry expertise.

Who You Are

• Required Qualifications
  • Current, active, and unrestricted state license issued by a state or territory of the United States to practice independently with a legal scope of practice that permits independent assessments: 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.
  • 2+ years of direct clinical care experience in substance use disorder treatment, care management, utilization management, or a related setting
  • Demonstrated knowledge of substance use disorders, co-occurring mental health conditions, SUD treatment modalities, and recovery principles.
  • Knowledge of ASAM Criteria and application of level of care determinations for substance use disorder treatment.
  • Excellent verbal and written communication and interpersonal skills
  • Strong computer and keyboarding skills (Microsoft Office Suite), including the ability to document while simultaneously while 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 and the ability to assume a role in ensuring that all objectives are met
  • Ability to work independently to meet case load requirements and team objectives/goals
  • Proven interest in professional development through specialization, certification, and/or advanced degree

• 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.