Behavioral Health Utilization Care Manager

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Authorize initial admissions and perform concurrent reviews to determine medical necessity at designated hospitals.

• Collaborate with facilities and outpatient service providers.

• Work alongside other reviewers when there are changes in patients’ continuum of care.

• Review and authorize behavioral health and substance abuse services across inpatient, residential, and outpatient settings using established medical necessity criteria.

• Monitor care to ensure treatment remains appropriate and effective.

• Evaluate members’ care plans and develop, implement, monitor, and document the utilization of resources and member progress.

• Provide telephonic or electronic document reviews.

• Engage with internal and external resources to support suitable care plans and discharge planning.

• Monitor for any quality-of-care issues.

• Conduct regular staffing meetings with medical directors.

• Provide education and suggest alternative care plans for treatments that do not meet medical necessity criteria.

• Identify and address barriers to effective healthcare delivery.

• Execute prior authorization, concurrent, retrospective, and appeal reviews as necessary.

• Manage individual members throughout the healthcare continuum.

• Lead initiatives for process improvement targeting patient populations.

• Assess medical necessity and the appropriateness of care provided.

• Establish collaborative relationships with physicians, payers, and healthcare team members.

• Gather and communicate information essential for utilization and regulatory compliance.

• Develop and oversee interdisciplinary patient discharge plans.

• Educate internal healthcare team members on case management and managed care concepts.

⛳️ Requirements

• A master’s degree in social work, counseling, or a related field, or possess independent or associate licensure.

• Licensure in at least one of the following categories as mandated by state law: Social work, professional counseling, or marriage and family therapy.

• Acceptable licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.

• A minimum of three years of clinical experience in areas such as counseling, care management, case management, or care coordination within inpatient or outpatient settings.

• Proficient knowledge of care management, case management, as well as hospital and community resources.

• Strong critical thinking skills, problem-solving capabilities, effective communication skills, and adept time management skills.

• Ability to work efficiently both independently and within an interdisciplinary team setting.

• Residency in Arizona is required for compliance purposes.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuous education.

• Supportive work environment with a focus on team collaboration.

• Access to resources that promote work-life balance.