Job FamilyClinical, UnlicensedJob Brief
We are currently seeking a dynamic Utilization Management Care Manager to join our team at our office in New York, NY!About the Position:
We are currently seeking a dynamic Utilization Management Care Manager
to join our team at our office in New York, NY
! The UM Care Manager
authorizes and reviews utilization of mental health and substance use services provided in inpatient and intermediate care settings; assists with discharge planning and ambulatory follow up activity provides member assistance with mental health and substance use issues, and participates in special utilization projects. Position Responsibilities:
- Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information and facilitate care in multiple settings.
- Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.
- Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.
- Clinicians are required to be educated in current principles, procedures of behavior health care. Managed care and state specific expertise and knowledge of community resources experience preferred.
- Performs telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned
- Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria
- Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria
- Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
- Provides information to members and providers regarding mental health and substance use benefits and community treatment resources
- Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources
- Identifies and refers high risk members to care management.
- Recognizes quality of care issues and reports them appropriately through internal and external processes.
- Interacts with providers and facilities in a professional, respectful manner
- Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
- Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
- Participates in clinical rounds
- Assists with NCQA, URAC and other QI initiatives
- Other duties as assigned
- Education: Master's degree or higher in a health related field and licensure as a behavioral health professional or RN.
- Licensure: Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) or BNS and must practice within the scope of license
- Relevant Work Experience: 3 years behavioral health clinical practice required and 5 years case management experience required
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Beacon Health Options Company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled
AAP Reporting Location:NY - Manhattan
ID (Req #):56163
FTE Status:Full Time
Schedule:40 hours per week