Behavioral Health Utilization Care Manager

Banner Health•Phoenix, AZ

1d•$28 - $46•Remote

About The Position

This position is the point person for all utilization activities for assigned members. As part of an interdisciplinary team, this position reviews and authorizes behavioral health and substance abuse services in inpatient, residential and outpatient settings using approved medical necessity criteria. Monitors care to ensure treatment is appropriate and effective. This position assesses the member’s plan of care and develops, implements, monitors and documents the utilization of resources and progress of the member through their care, facilitating options and services to meet the member’s health care needs. This position provides telephonic or electronic document review. This position engages internal and external resources to ensure members receive appropriate care plan and discharge planning services. This position monitors for quality of care concerns. Will staff regularly with medical directors. Within the scope of their position and licensure, this position will provide education and recommend alternative care plans for treatment not meeting medical necessity criteria. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective care delivery to members. May conduct prior authorization, concurrent, retrospective, and appeal reviews.

Requirements

Requires master’s degree in social work, counseling or related field or with independent or associate licensure.
Licensure in at least one of the following categories as required by state law: Social work, professional counseling or marriage and family. Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.
Requires a proficiency level typically achieved with three years clinical experience (i.e. counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
Must have a working knowledge of care management, case management, hospital and community resources.
Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
Must demonstrate ability to work effectively independently and in an interdisciplinary team format.
Requires Arizona residency for compliance.

Nice To Haves

Previous experience with behavioral health utilization management.
Additional related education and/or experience preferred.

Responsibilities

Manages individual members across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
Establishes and promotes a collaborative relationship with physicians, other payers, and other members of the health care team. Collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.
Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
Has the freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations.
Authorize initial admitting and do concurrent reviews for medical necessity.
Working with facilities and out-patient providers and will collaborate with other reviewers if there is a change to patients continuum of care.
Utilize clinical experience, excellent collaboration skills, strong time management, and ability to be a strong communicator to meet requirements for compliancy and member care.