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.

• 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.

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

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

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

• Collaborate with Physician Advisors on clinical and authorization inquiries.

• Take part in quality improvement activities, including data gathering, tracking, and analysis.

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

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

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

• Advocate for patients and interact professionally with providers to facilitate treatment.

⛳️ Requirements

• Active licensure that meets State, Commonwealth, or customer-specific standards.

• One or more required licenses/credentials: CEAP, LMSW, LCSW, LSW, LPC, or RN.

• Relevant degree associated with the required licensure.

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

• Excellent organization, time management, and communication skills.

• 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 current diagnostic edition.

• Capability to analyze specific utilization issues, plan, and implement solutions that positively impact the quality of care.

• Must hold a license in Pennsylvania.

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary, and additional benefits.

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

• Equal Opportunity Employer.

• Tobacco-free workplace.