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.