Care Manager BH - Hollidaysburg, PA
About The Position
Under general supervision and in collaboration with the clinical team, the Care Manager BH authorizes and reviews utilization of mental health and substance abuse services in inpatient and/or outpatient settings. The role monitors levels of care for medical necessity and effectiveness, conducts concurrent clinical reviews, collects and analyzes utilization data, and helps coordinate care and discharge planning. It also provides member assistance, telephone triage, crisis intervention, and emergency authorizations as assigned. The position is onsite at the Blair County OMH office in Hollidaysburg, Pennsylvania, and works Monday through Friday; remote work is not available. Experience working with children, adolescents, and families in IBHS services is preferred. The Care Manager educates members and providers about benefits, community resources, managed care programs, policies, procedures, and criteria. The position collaborates with providers, facilities, community agencies, and Physician Advisors; recommends alternative treatment plans when requests do not meet medical necessity; supports provider network development; advocates for members’ treatment needs; and participates in quality improvement projects and activities. Additional duties aligned with the job may be assigned.
Requirements
- Current license meeting applicable state, Commonwealth, or customer-specific requirements; one or more of CEAP, LMSW, LCSW, LSW, LPC, or RN is required.
- 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.
- Required education listed: Associate degree in Nursing, Bachelor's degree in Social Work, or Master's degree in Social Work.
Nice To Haves
- Experience working with children, adolescents, and families in IBHS services is preferred.
Responsibilities
- Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient settings.
- Monitor 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, outpatient, and other levels of care within scope of practice and experience.
- Develop discharge plans with providers and facilities and oversee implementation.
- Conduct quality clinical reviews, educate stakeholders, and make appropriate interventions to advance member care.
- Provide information to members and providers about benefits, community treatment resources, managed care programs, company policies and procedures, and criteria.
- Consult Physician Advisors about clinical and authorization questions and concerns regarding 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’ treatment needs and interact professionally and respectfully with providers.
- Assist with care coordination and discharge planning.
- Collect and analyze utilization data.
Benefits
- Comprehensive benefits package.
- Health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
- May be eligible for short-term incentives.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
