Care Manager – UM/UR

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

📋 Description

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

• Gather and evaluate utilization data.

• Support discharge planning and care coordination efforts.

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

• Oversee levels of care to guarantee medical necessity and efficacy.

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

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

• Create discharge plans in collaboration with providers and facilities, ensuring proper implementation.

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

• Supply members and providers with details about benefits, community resources, managed care programs, policies, procedures, and criteria.

• Collaborate with Physician Advisors regarding clinical and authorization inquiries.

• Engage in quality improvement initiatives, including data collection, tracking, and analysis.

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

• Partner with community organizations.

• Suggest alternative treatment plans when services fail to meet medical necessity criteria.

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

• Advocate for patients and facilitate their treatment process with providers.

⛳️ Requirements

• Current licensure that meets State, Commonwealth, or specific customer requirements is mandatory.

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

• State and/or Compact State Licensure is required.

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

• Strong organizational, time management, and communication abilities.

• Familiarity with utilization management processes.

• Knowledge of mental health and substance abuse community resources and providers.

• Experience in inpatient and/or outpatient environments.

• Understanding of DSM V or the most recent diagnostic edition.

• Capability to assess utilization issues and implement solutions that enhance the quality of care.

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary, and various other benefits.

• Perks for physical, mental, emotional, and financial wellbeing.

• Opportunities for professional growth and development.

• Total health and wellness support.

• Recognition and rewards.

• Fostering employee unity.

• A tobacco-free workplace.