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.
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 #):
40 hours per week
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.