Care Manager II – Utilization Management

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

📋 Description

• Oversee psychiatric and substance use disorder facility-based and outpatient professional treatment health benefits through telephonic or written evaluations.

• Utilize screening criteria knowledge and clinical judgment to evaluate member needs and facilitate access to medically necessary, high-quality behavioral healthcare in a cost-efficient manner.

• Implement UM Clinical Guidelines and contractual obligations.

• Refer cases to Peer Reviewers when appropriate.

• Conduct psychiatric and substance abuse assessments, coordination, implementation, case planning, monitoring, and evaluation.

• Enhance quality member outcomes and maximize member health benefits.

• Encourage effective utilization of health benefits and community resources.

• Act as a resource for other Behavioral Health Care Managers.

• Assist with more intricate cases.

• Engage in inter- and intradepartmental team projects and initiatives.

⛳️ Requirements

• MA/MS in social work, counseling, or a related behavioral health discipline, with a minimum of 3 years of experience in facility-based and/or outpatient psychiatric and substance use disorder treatment; or an equivalent combination of education and experience.

• Current, active, unrestricted license, such as LCSW, LMSW, LMHC, LPC, LMFT, or Clinical Psychologist license, is mandatory.

• Prior experience in case management/utilization management with complex psychiatric/substance abuse cases is required.

• Previous managed care experience is essential.

• Excellent oral, written, and interpersonal communication skills are required.

• Strong problem-solving capabilities.

• Facilitation abilities.

• Analytical skills are necessary.

• California licensed clinician is highly preferred.

• Availability to work Monday–Friday, 8:30 am–5:00 pm Pacific Standard Time.

• Candidates must live within a reasonable commuting distance from the job location unless an accommodation is made.

• New candidates in specific patient/member-facing roles must be vaccinated against COVID-19 and Influenza, unless a valid exemption is provided.

🏝️ Benefits

• Comprehensive benefits package.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with match.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Required in-person training sessions.

• Flexible virtual work arrangements.