Care Manager BH (Onsite, PA, Hollidaysburg)
About The Position
The Care Manager BH works under general supervision and in collaboration with other clinical team members to authorize and review 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, provides member assistance, and participates in quality improvement projects. The position is onsite, Monday through Friday, at the Blair County OMH office in Hollidaysburg, Pennsylvania; remote work is not available. The employer is seeking behavioral health clinicians with experience working with children, adolescents, and families, preferably in IBHS services. The Care Manager monitors levels of care for medical necessity and effectiveness; conducts telephone triage, crisis intervention, and emergency authorizations as assigned; and performs concurrent clinical reviews within the scope of practice and experience. In conjunction with providers and facilities, the role develops and oversees discharge plans, conducts quality clinical reviews, and makes interventions to advance member care. The Care Manager provides information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria; consults Physician Advisors on clinical and authorization questions; and participates in quality improvement data collection, tracking, and analysis. The role maintains an active workload according to National Care Manager performance standards, works with community agencies, proposes alternative treatment plans when service requests do not meet medical necessity criteria, and may assist with network development by identifying and recruiting quality providers. The Care Manager advocates for patients and interacts professionally and respectfully with providers. Listed duties are representative rather than exhaustive, and additional duties aligned with the role may be assigned.
Requirements
- Current licensure meeting state, Commonwealth, or customer-specific requirements; one or more of CEAP, LMSW, LCSW, LSW, LPC, or RN is required, with the necessary degree.
- 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, mental health and substance abuse community resources, and providers.
- Knowledge and experience in an inpatient and/or outpatient setting.
- 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.
Nice To Haves
- Experience working with children, adolescents, and families.
- Experience in IBHS services.
Responsibilities
- Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings.
- Collect and analyze utilization data.
- Assist with discharge planning and care coordination.
- Provide members with assistance related to 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.
- Interact with Physician Advisors regarding clinical and authorization questions and concerns about 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 with providers professionally and respectfully.
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
