Care Manager - BH - Hollidaysburg, PA
About The Position
The Care Manager - BH works under general supervision and in collaboration with other clinical team members to authorize and review the utilization of mental health and substance abuse services in inpatient and/or outpatient settings. The role collects and analyzes utilization data, assists with discharge planning and care coordination, supports members with mental health and substance abuse issues, and participates in quality improvement projects. The position monitors levels of care to ensure medical necessity and effectiveness; performs telephone triage, crisis intervention, emergency authorizations, and concurrent reviews as assigned and within scope of practice and experience. In collaboration with providers and facilities, the Care Manager develops and oversees discharge plans, conducts quality clinical reviews, and makes interventions to advance member care. The role also provides information about benefits, community resources, managed care programs, policies, procedures, and criteria; consults Physician Advisors on clinical and authorization questions; and works with community agencies and providers. The Care Manager maintains an active workload in accordance with National Care Manager performance standards, proposes alternative treatment plans when requests do not meet medical necessity criteria, may assist with network development, and advocates for members’ treatment needs. Additional duties aligned with the role may be assigned. This is a full-time, onsite position at the Blair County OMH office, 81 Holliday Hills Dr., Hollidaysburg, Pennsylvania. The schedule is Monday through Friday; remote work is not available. The position may be eligible for short-term incentives and includes a comprehensive benefits package.
Requirements
- Current licensure meeting state, Commonwealth, or customer-specific requirements; one or more of the listed licenses is required with the necessary degree.
- At least one of the following licenses: CEAP, LMSW, LCSW, LSW, LPC, or RN.
- At least 2 years of post-degree experience in a healthcare, behavioral health, psychiatric, and/or substance abuse healthcare setting.
- Strong organizational, time-management, and communication skills.
- Knowledge of utilization management procedures and mental health and substance abuse community resources and providers.
- Knowledge and experience in inpatient and/or outpatient settings.
- Knowledge of DSM V or the most current diagnostic edition.
- Ability to analyze utilization problems and plan and implement solutions that directly influence quality of care.
- Education required: Associate degree in Nursing, Bachelor's degree in Social Work, or Master's degree in Social Work.
Responsibilities
- Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient settings.
- Collect and analyze utilization data.
- Assist with discharge planning and care coordination.
- Provide member assistance with mental health and substance abuse issues.
- Monitor levels of care to ensure medical necessity and effectiveness.
- Provide telephone triage, crisis intervention, and emergency authorizations as assigned.
- Perform concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
- Develop discharge plans with providers and facilities and oversee their implementation.
- Perform quality clinical reviews and make appropriate interventions to advance member care.
- Provide members and providers with information about benefits, community treatment resources, managed care programs, company policies and procedures, and criteria.
- Consult Physician Advisors about clinical and authorization questions and concerns for specific cases.
- Participate in quality improvement activities, including data collection, tracking, and analysis.
- Maintain an active workload in accordance with National Care Manager performance standards.
- Work with community agencies as appropriate.
- Propose alternative treatment plans when service requests do not meet medical necessity criteria.
- Participate in network development, including identifying and recruiting quality providers as needed.
- Advocate for patients to ensure treatment needs are met and interact professionally and respectfully with providers.
- Perform additional duties aligned with the intent of the role as assigned by a leader.
Benefits
- May be eligible for short-term incentives.
- Comprehensive benefits package.
- Health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
