• Managing psychiatric and substance abuse or substance abuse disorder health benefits through telephonic or written review
• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs
• Refers cases to Peer Reviewers as appropriate
• Performs psychiatric and substance abuse or substance abuse disorder assessment coordination

Requirements

Requires MA/MS in social work, counseling, or a related behavioral health field
Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
Current active unrestricted license such as RN, LCSW, LMSW, LMHC, LPC, LBA, LMFT, or Clinical Psychologist
Previous experience in case management/utilization management with complex psychiatric/substance abuse cases required
Prior managed care experience required

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Hard Skills

psychiatric assessment
substance abuse assessment
case management
utilization management
clinical judgment
screening criteria

Soft Skills

communication
interpersonal skills
organizational skills

Certifications & Qualifications

RN
LCSW
LMSW
LMHC
LPC
LBA
LMFT
Clinical Psychologist

Behavioral Health Care Manager II

Manager, Broker Experience

Account Service Manager

Strategic Vendor Manager

Senior Manager, Partner Product

Estimating Team Manager