Professional, Behavioral Health

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Professional, Behavioral Health to join #TeamMVP. If you have a passion for healthcare, improving access to care, enhancing quality and compliance this is the opportunity for you. What's in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. 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. Qualifications you'll bring: 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 Your key responsibilities: 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. Where you'll be: Virtual in NYS Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. MVP's Inclusion Statement At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at hr@mvphealthcare.com .