Care Manager, BH

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

📋 Description

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

• Gather and analyze utilization statistics.

• Aid in discharge planning and care coordination.

• Provide support for members dealing with mental health and substance abuse challenges.

• Engage in quality improvement initiatives and activities.

• Monitor care levels to ensure medical necessity and effectiveness.

• Offer 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 execution.

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

• Inform members and providers about benefits, community 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 fail to meet medical necessity criteria.

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

• Advocate for patients while maintaining professional interactions with providers.

⛳️ Requirements

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

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

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

• Strong organizational, time management, and communication abilities.

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

• Knowledge and experience in both inpatient and outpatient settings.

• Proficiency in DSM V or the latest diagnostic edition.

• Capability to analyze utilization challenges 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.

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

🏝️ Benefits

• Short-term incentives may be offered.

• Comprehensive benefits package available.

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

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

• Tobacco-free workplace environment.