Care Manager, BH

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

📋 Description

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

• Gather and assess utilization data.

• Assist in discharge planning and care coordination.

• Offer member support for mental health and substance abuse concerns.

• Monitor care levels to confirm medical necessity and effectiveness.

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

• Conduct concurrent reviews for inpatient and outpatient care, as well as other care levels within the scope of practice and experience.

• Create discharge plans in collaboration with providers and facilities and oversee their execution.

• Carry out quality clinical reviews, educate stakeholders, and take action to enhance member care.

• Provide information regarding benefits, community treatment resources, managed care programs, and company policies, procedures, and criteria.

• Engage with Physician Advisors concerning clinical and authorization inquiries.

• Contribute to quality improvement initiatives, including data collection, tracking, and analysis.

• Maintain an active workload in alignment with National Care Manager performance standards.

• Collaborate with community agencies and suggest alternative treatment plans when services do not satisfy medical necessity criteria.

• Engage in network development by identifying and recruiting high-quality providers.

• Advocate for patients while interacting professionally with providers to facilitate treatment.

⛳️ Requirements

• Licensed behavioral health professional in Pennsylvania.

• Experience working with children and adolescents.

• Preferable experience with Intensive Behavioral Health Services levels of care, BHRS, and/or ABA.

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

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

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

• Strong organizational, time management, and communication abilities.

• Understanding of utilization management processes.

• Familiarity with mental health and substance abuse community resources and providers.

• Knowledge and experience in inpatient and outpatient settings.

• Familiarity with DSM V or the most current diagnostic edition.

• Capability to analyze specific utilization challenges, devise, and implement solutions that directly impact care quality.

• Required education: Associate's in Nursing, Bachelor's in Social Work, or Master's in Social Work.

• Must adhere to applicable legal, regulatory, contractual, security, and internal policy requirements.

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary, and other benefits.

• Benefits and perks that support physical, mental, emotional, and financial well-being.

• Tobacco-free workplace.

• Equal Opportunity Employer.