Care Manager, UM/UR

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

📋 Description

• Authorize and evaluate the use of inpatient and outpatient mental health and substance abuse services.

• Gather and assess utilization data.

• Aid in discharge planning and care coordination.

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

• Engage in quality improvement initiatives.

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

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

• Conduct concurrent reviews for both inpatient and outpatient care.

• Create discharge plans in collaboration with providers and facilities, overseeing their execution.

• Execute quality clinical reviews while educating members and providers.

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

• Collaborate with Physician Advisors on clinical and authorization inquiries.

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

• Partner with community organizations to propose alternative treatment plans when services do not align with medical necessity criteria.

• Contribute to network development, including identifying and recruiting quality providers.

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

⛳️ Requirements

• Current licensure that meets state, Commonwealth, or customer-specific criteria.

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

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

• Idaho licensure is mandatory; candidates residing outside Idaho must also hold a license in their state of residence.

• Strong organizational, time management, and communication abilities.

• Familiarity with utilization management processes.

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

• Experience in inpatient and/or outpatient settings.

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

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

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

🏝️ Benefits

• Short-term incentives may be available.

• Comprehensive benefits package.

• Health, life, voluntary, and additional benefits.

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

• Tobacco-free workplace.

• Equal Opportunity Employer.