Care Manager – BH
Job Description:
- Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
- Provides telephone triage, crisis intervention, and emergency authorizations as assigned.
- Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
- In conjunction with providers and facilities, develop discharge plans and oversee their implementation.
- Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
- Participates in quality improvement activities, including data collection, tracking, and analysis.
- Maintains an active workload in accordance with National Care Manager performance standards.
- Works with community agencies as appropriate.
- Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
- Participates in network development including identification and recruitment of quality providers as needed.
- Advocates for the patient to ensure treatment needs are met.
- Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Responsibilities:
- Licensure is required for this position, specifically, a current license that meets State, Commonwealth, or customer-specific requirements.
- One or more of the following licensure is required for this role with the necessary degrees: CEAP, LMSW, LCSW, LPC, RN, or LPN.
- Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare setting. Strong organization, time management, and communication skills.
- Knowledge of utilization management procedures, mental health, and substance abuse community resources and providers. Knowledge and experience in inpatient and/or outpatient settings.
- Knowledge of DSM V or the most current diagnostic edition.
- Ability to analyze specific utilization problems, and plan and implement solutions that directly influence quality of care.
Work Experience:
- Clinical 2+ years
Certification:
- Must be Independently licensed in the State of California.
- Must have one of the following: CEAP – Certified Employee Assistance Professional, LCSW – Licensed Clinical Social Worker, LMFT – Licensed Marriage and Family Therapist, LMSW – Licensed Master Social Worker, LPC – Licensed Professional Counselor, LPN – Licensed Practical Nurse, RN – Registered Nurse, State and/or Compact State Licensure
Top 3 Must-Haves (Hard Skills):
- Business management experience
- Computer knowledge
- Stable hard-wired fast internet
- Private workspace that abides by HIPPA standards
Nice-To-Haves (Hard Skills):
- Hospital/ Healthcare background
Education:
- Dependent on Certification–Associates: Nursing, Bachelors: Social Work, Masters: Social Work (Required)
100 percent remote – Must reside in California
Duration: 9-12 months contract, (Possible Temp-to-hire)
Standard Hours: 8:30 AM – 5 PM (PST) Monday – Friday (Lunches and Breaks are scheduled) Must have some flexibility
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
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