JOB DESCRIPTION
ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner
companies to source qualified talent for their open roles. The following
position is available to Veterans, Transitioning Military, National Guard and
Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If
you have the required skill set, education requirements, and experience, please
click the submit button and follow the next steps.
Under general supervision, and in collaboration with other members of the
clinical team, authorizes and reviews utilization of mental health and substance
abuse services provided in inpatient and/or outpatient care settings. Collects
and analyzes utilization data. Assists with discharge planning and care
coordination. Provides member assistance with mental health and substance abuse
issues, and participates in special quality improvement projects.
Monitors inpatient and/or outpatient level of care services related to
mental health and substance abuse treatment to ensure medical necessity and
effectiveness.
Provides telephone triage, crisis intervention and emergency authorizations
as assigned.
Performs concurrent reviews for inpatient and/or outpatient care and other
levels of care as allowed by scope of practice and experience.
In conjunction with providers and facilities, develops discharge plans and
oversee their implementation.
Performs quality clinical reviews while educating and making appropriate
interventions to advance the care of the member in treatment.
Provides information to members and providers regarding mental health and
substance abuse benefits, community treatment resources, mental health managed
care programs, and company policies and procedures, and criteria.
Interacts with Physician Advisors to discuss clinical and authorization
questions and concerns regarding specific cases.
Participates in quality improvement activities, including data collection,
tracking, and analysis.
Maintains an active work load in accordance with National Care Manager
performance standards.
Works with community agencies as appropriate. Proposes alternative plans of
treatment when requests for services do not meet medical necessity criteria.
Participates in network development including identification and recruitment
of quality providers as needed.
Advocates for the patient to ensure treatment needs are met. Interacts with
providers in a professional, respectful manner that facilitates the treatment
process.
The job duties listed above are representative and not intended to be
all-inclusive of what may be expected of an employee assigned to this job. A
leader may assign additional or other duties which would align with the intent
of this job, without revision to the job description.
#LI-Remote
ADDITIONAL QUALIFICATIONS/RESPONSIBILITIES
Licensure is required for this position, specifically a current license that
meets State, Commonwealth or customer-specific requirements.
One or more of the following licensure is required for this role with necessary
degrees: CEAP, LMSW, LCSW, LSW, LPC or RN.
Minimum 2 years experience post degree in healthcare, behavioral health,
psychiatric and/or substance abuse health care setting.
Strong organization, time management and communication skills.
Knowledge of utilization management procedures, mental health and substance
abuse community resources and providers.
Knowledge and experience in inpatient and/or outpatient setting.
Knowledge of DSM V or most current diagnostic edition.
Ability to analyze specific utilization problems, plan and implement solutions
that directly influence quality of care.
General Job Information
Title
Care Manager, BH - Remote
Grade
25
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associate - Nursing, Bachelor's - Social Work, Master's - Social Work
Education - Preferred
License and Certifications - Required
CEAP - Certified Employee Assistance Professional - Care MgmtCare MgmtCare Mgmt,
LCSW - Licensed Clinical Social Worker - Care MgmtCare MgmtCare Mgmt, LMFT -
Licensed Marital and Family Therapist - Care MgmtCare MgmtCare Mgmt, LMSW -
Licensed Master Social Worker - Care MgmtCare MgmtCare Mgmt, LPC - Licensed
Professional Counselor - Care MgmtCare MgmtCare Mgmt, LSW - Licensed Social
Worker - Care MgmtCare MgmtCare Mgmt, RN - Registered Nurse, State and/or
Compact State Licensure - Care MgmtCare MgmtCare Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$64,285
Salary Maximum:
$102,855