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 environments.

• Gather and evaluate utilization data.

• Aid in discharge planning and care coordination activities.

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

• Engage in quality improvement initiatives.

• Supervise levels of care to ensure medical necessity and effectiveness.

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

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

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

• Execute quality clinical reviews and provide education to members and providers.

• Share information regarding behavioral health benefits, community resources, managed care programs, policies, procedures, and criteria.

• Collaborate with Physician Advisors concerning clinical and authorization inquiries.

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

• Partner with community organizations.

• Suggest alternative treatment plans when services do not satisfy medical necessity criteria.

• Contribute to network development by identifying and attracting quality providers.

• Advocate for patients and maintain professional interactions with providers.

⛳️ Requirements

• Licensed behavioral health professional in Pennsylvania.

• Experience working with children and adolescents.

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

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

• One or more of the following required licensures: CEAP, LMSW, LCSW, LSW, LPC, or RN.

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

• Excellent organization, time management, and communication abilities.

• Familiarity with utilization management procedures, as well as mental health and substance abuse community resources and providers.

• Knowledge and experience in both inpatient and outpatient settings.

• Understanding of DSM V or the most up-to-date diagnostic edition.

• Ability to assess utilization issues and implement solutions that enhance quality of care.

• Adherence to all relevant legal, regulatory, contractual, security, and internal policy requirements.

• Required education includes an Associate in Nursing, Bachelor’s in Social Work, or Master’s in Social Work.

🏝️ Benefits

• Potential availability of short-term incentives.

• Comprehensive benefits package.

• Health benefits.

• Life insurance benefits.

• Voluntary benefits.

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

• Tobacco-free workplace.