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.

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

• Supervise inpatient and outpatient level-of-care services for medical necessity and effectiveness.

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

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

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

• Execute quality clinical reviews, educate stakeholders, and implement interventions to enhance member care.

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

• Communicate with Physician Advisors regarding clinical and authorization inquiries.

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

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

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

• Advocate for patients while maintaining professional interactions with providers.

⛳️ Requirements

• Must hold a valid license in Pennsylvania.

• Current license must meet State, Commonwealth, or customer-specific criteria.

• One or more required licensure credentials: CEAP, LMSW, LCSW, LSW, LPC, or RN, alongside necessary degrees.

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

• Strong skills in organization, time management, and communication.

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

• Familiarity and experience in inpatient and outpatient settings.

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

• Ability to analyze specific utilization issues and execute solutions that influence the quality of care.

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

• Necessary licenses/certifications include CEAP, LCSW, LMFT, LMSW, LPC, LSW, or RN State and/or Compact State Licensure.

• Adherence to security responsibilities, legal, regulatory, contractual requirements, and internal policies and procedures.

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary benefits, and additional perks.

• Tobacco-free workplace.