The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Behavioral Health Utilization Review Clinician to perform utilization reviews for behavioral health treatment at all levels of care and Care Coordination for members with Behavioral Health needs. HPSM and San Mateo County have a robust and complex set of Behavioral Health resources for its members. This role is positioned for significant impact on member access and engagement with services. Holding a broad reaching role in Utilization review and Care Coordination allows for real time and impactful intervention and follow through between Health Plan, provider and member.
Are you a dynamic clinician with a positive outlook who is committed to bettering the mental health of the community? Does delivering timely and cost effective care appeal to you? Do you want to empower members by facilitating services to meet their clinical care needs across the continuum?
You may be HPSM’s new Behavioral Health Utilization Review Clinician!
Essential duties and responsibilities
Manage inpatient and outpatient mental health treatment authorization requests
Determine if additional clinical treatment sessions are needed
Attend Interdisciplinary meetings at hospitals or with BHRS for complex cases.
Coordinate an interdisciplinary approach to support continuity of care. Provide utilization management, transfer coordination, discharge planning, and issuance of all appropriate authorizations for covered services as needed for members.
Identify ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas.
Coordinate care for members to ensure that mental and physical health care needs are met.
Responsible for the early identification and assessment of members for potential inclusion in a comprehensive case management program. Refer members for Case Management accordingly.
Utilize appropriate resources to guide review decisions and document decisions clearly and concisely.
Monitor, track, and report on all work conducted.
Complete all required documentation and telephonic member follow-up within specified computer systems and within the required timeframes.
In conjunction with the Care and Transitions team, provide care coordination and referral to services to ensure that a member’s needs are met.
Participation in IDT/ICT meetings and clinical huddles as needed.
Education and Experience:
Master's degree in Social Work, Psychology, Counseling or Marriage or Family Counseling or above.
Current unrestricted CA licensure as LMFT, LCSW or Psychologist.
2 years of experience in mental health and/or substance abuse treatment environment
Highly Preferred Experience:
Working in Utilization Review or Case Management
Working in an interdisciplinary team environment with community partners, public agencies and/or government programs
Working with a diverse population (e.g. persons with disabilities, low incomes, seniors)
Compensation and Benefits
Starting Compensation Range: - Depending on Experience
Benefits Information: Excellent benefits package offered, including
HPSM paid premiums for employee’s Medical, Dental and Vision coverage.
95% HPSM paid dependent premiums medical and dental benefits.
Fully paid life, AD&D, and LTD insurance
Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
Holiday and vacation pay
Tuition reimbursement plan
Onsite fitness center
Internal Number: 22-636 - 22-655
About Health Plan of San Mateo
HPSM is a local community-based health plan with a vision that Healthy is for Everyone – and we fight to make that possible. By partnering with providers and community organizations, we are able to advocate for the health of our members and meet the highest standards for quality of care. Learn more about our Mission, Vision and Values