Care Manager – BH
*This is a 6-month contract position – Remote CA resident Only and licensed in CA
*Hours: 8 or 8:30 am – 4:40 or 5 PM
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 the scope of practice and experience.
- In conjunction with providers and facilities, develops discharge plans and oversees 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, 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 that 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 licensures is required for this role with necessary degrees: CEAP, LMSW, LCSW, LPC, RN, or LPN.
- Minimum 2 years of experience post-degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare settings.
- 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, plan and implement solutions that directly influence the quality of care.
Top 3 Must-Haves (Hard and/or soft Skills)
- Tech savvy, Basic computer literacy, Behavioral health experience
Top 3 Nice-To-Haves (Hard and/or soft Skills)
- Crisis management, Psychiatric or UM experience
Experience:
- Clinical 2+ years
Certification:
- 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
Education:
- Dependent on Certification–Associates: Nursing, Bachelors: Social Work, Masters: Social Work (Required)
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