Care Manager, BH

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

📋 Description

• Authorize and assess the use of mental health and substance abuse services in both inpatient and outpatient care environments.

• Gather and evaluate utilization data.

• Assist in discharge planning and coordinate care.

• Offer support to members regarding mental health and substance abuse concerns.

• Monitor care levels to confirm medical necessity and effectiveness.

• Provide telephone triage, crisis intervention, and emergency authorizations.

• Conduct concurrent reviews for inpatient, outpatient, and other relevant care levels.

• Collaborate with providers and facilities to develop discharge plans and oversee their implementation.

• Execute quality clinical reviews while educating both members and providers.

• Supply information regarding benefits, community resources, managed care programs, policies, procedures, and criteria.

• Consult with Physician Advisors on clinical and authorization inquiries.

• Engage in quality improvement initiatives, including data collection, tracking, and analysis.

• Maintain workload in accordance with National Care Manager performance standards.

• Collaborate with community agencies and suggest alternative treatment plans when services fail to meet medical necessity criteria.

• Participate in network development and the identification and recruitment of providers.

• Advocate for patients while maintaining professional interactions with providers.

• Perform additional responsibilities as assigned by a leader that align with the role.

⛳️ Requirements

• Current license that meets State, Commonwealth, or customer-specific criteria.

• One or more of the following required licenses: CEAP, LMSW, LCSW, LSW, LPC, or RN, along with necessary degrees.

• At least 2 years of post-degree experience in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare settings.

• Strong organizational, time management, and communication abilities.

• Familiarity with utilization management protocols.

• Knowledge of mental health and substance abuse community resources and providers.

• Experience in both inpatient and outpatient settings.

• Understanding of DSM V or the most current diagnostic edition.

• Capability to analyze utilization challenges and devise and implement solutions that enhance quality of care.

• Required educational qualifications include an Associate in Nursing, Bachelor's in Social Work, or Master's in Social Work.

• Committed to security responsibilities and compliance with relevant legal, regulatory, contractual, and internal standards.

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary, and additional benefits.

• Benefits and perks that promote physical, mental, emotional, and financial wellbeing.

• Tobacco-free workplace.

• Equal Opportunity Employer.