Care Manager BH - Hollidaysburg, PA

Military Spouse Corporate Career Network • Hollidaysburg, PA

10d • Onsite

About The Position

Under general supervision and in collaboration with other members of the clinical team, the Care Manager BH authorizes and reviews utilization of mental health and substance abuse services in inpatient and/or outpatient care settings. The role monitors level-of-care services for medical necessity and effectiveness, analyzes utilization data, assists with discharge planning and care coordination, and provides member assistance regarding mental health and substance abuse issues. The position also includes telephone triage, crisis intervention, and emergency authorizations as assigned.

The Care Manager performs concurrent and other clinical reviews within the limits of scope of practice and experience; develops discharge plans with providers and facilities and oversees their implementation; and conducts quality clinical reviews, educating and intervening to advance member care. The role provides information to members and providers about benefits, community resources, managed care programs, policies, procedures, and criteria; consults Physician Advisors about clinical and authorization questions; participates in quality improvement and network development; works with community agencies; proposes alternative treatment plans when requests do not meet medical necessity criteria; and advocates for members’ treatment needs.

This is an onsite, full-time position at the Blair County OMH office in Hollidaysburg, Pennsylvania. The schedule is Monday through Friday, and remote work is not available. The organization is seeking behavioral health clinicians with experience working with children, adolescents, and families, preferably in IBHS services. Duties listed are representative and not all-inclusive; 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 organization, time management, and communication skills.
• Knowledge of utilization management procedures and 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.
• Education required: Associate degree in Nursing, bachelor's degree in Social Work, or master's degree in Social Work.
• Onsite availability at the Blair County OMH office in Hollidaysburg, Pennsylvania, Monday through Friday; remote work is unavailable.

Nice To Haves

• Experience working with children, adolescents, and families, preferably 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 member assistance with mental health and substance abuse issues.
• Monitor inpatient and/or outpatient levels of care to ensure medical necessity and treatment 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 permitted by scope of practice and experience.
• Develop discharge plans with providers and facilities and oversee their implementation.
• Perform quality clinical reviews, educate, and make appropriate interventions to advance member care.
• Provide members and providers with information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria.
• Consult 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 their treatment needs are met.
• Interact with providers professionally and respectfully to facilitate the treatment process.

Benefits

• Comprehensive benefits package.
• Broad range of health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
• May be eligible for short-term incentives.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree