Care Manager, BH – Louisiana License Required

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

📋 Description

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

• Gather and evaluate utilization data.

• Support discharge planning and facilitate care coordination.

• Offer assistance to members dealing with mental health and substance abuse challenges.

• Engage in special quality improvement initiatives.

• Oversee levels of care to confirm medical necessity and effectiveness.

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

• Conduct concurrent reviews for inpatient and outpatient care, as well as other care levels within the scope of practice and experience.

• Create discharge plans in collaboration with providers and facilities and supervise their implementation.

• Execute quality clinical reviews while educating both members and providers.

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

• Collaborate with Physician Advisors on clinical and authorization inquiries.

• Take part in quality improvement efforts, which include data collection, tracking, and analysis.

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

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

• Contribute to network development by identifying and recruiting high-quality providers.

• Advocate for patients while maintaining professional interactions with providers.

⛳️ Requirements

• Applicants must hold a valid license in Louisiana.

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

• One or more required licenses/certifications include CEAP, LMSW, LCSW, LSW, LPC, LMFT, or RN with the appropriate degrees.

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

• Strong organizational, time management, and communication skills are necessary.

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

• Experience in both inpatient and outpatient settings is required.

• Knowledge of DSM V or the most current diagnostic edition is essential.

• Ability to analyze utilization issues and develop and execute solutions that enhance the quality of care.

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

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package offered.

• Health benefits included.

• Life benefits available.

• Voluntary benefits offered.

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

• Equal Opportunity Employer.

• Tobacco-free workplace.