Clinician, Clinical Operations - SUD

What You Will Do - Essential Function

The Substance Use Disorder (SUD) Clinical Ops Clinician provides integrated care management and utilization management services to support members with substance use disorders across the continuum of care. This role conducts clinical assessments, develops individualized care plans, promotes member engagement and recovery, reviews and processes authorization requests, evaluates medical necessity, facilitates discharge planning, and coordinates referrals to appropriate levels of care and community resources.

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