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 interpret utilization data.

• Aid in discharge planning and care coordination.

• Offer support to members dealing with mental health and substance abuse concerns.

• Engage in quality enhancement initiatives.

• Supervise levels of care 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.

• Execute quality clinical reviews, educate members and providers, and implement interventions to improve care.

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

• Communicate with Physician Advisors on clinical and authorization inquiries.

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

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

• Collaborate with community organizations and propose alternative treatment strategies when services do not 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

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

• One or more of the following licenses with requisite degrees: 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 organizational, time management, and communication abilities.

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

• Knowledge and experience in inpatient and/or outpatient environments.

• Understanding of DSM V or the latest diagnostic edition.

• Capability to analyze utilization issues and devise and implement solutions that enhance quality of care.

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

• All employees must comprehend, adhere to, and confirm security responsibilities and controls specific to their position, in addition to relevant legal, regulatory, contractual, and internal policy requirements.

🏝️ Benefits

• Short-term incentives may be offered.

• Comprehensive benefits package.

• Health benefits.

• Life benefits.

• Voluntary benefits.

• Additional benefits and perks that support physical, mental, emotional, and financial wellbeing.

• Tobacco-free workplace.

• Equal opportunity employer.