Manage psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review
Use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract
Refer cases to Peer Reviewers as appropriate
Perform psychiatric and substance abuse assessment coordination, implementation, case planning, monitoring and evaluating to promote quality member outcomes and optimize member health benefits
Promote effective use of health benefits and community resources
Serve as a resource to other BH Care Managers and assist with more complex cases
Participate in inter and intradepartmental teams, projects and initiatives
Requirements
Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing
minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
or any combination of education and experience which would provide an equivalent background
Current, active, unrestricted license such as either a RN (must have exp in behavioral health), LCSW, LMHC, LPC, LCPC (as allowed by applicable state laws) LMFT licensed in the United States. Licensure is a requirement for this position
Prior managed care experience required
Work Shift Hours: Monday through Friday, 12:00 pm (EST) to 8:30 pm (EST)
Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
Benefits
a comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical, dental, vision
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources
comprehensive employee assistance program
work/life support
Flexible/virtual work arrangements (virtual full-time with in-person training)
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.