Care Manager BH - Remote in Louisiana LA Only

Military Spouse Corporate Career Network•Baton Rouge, LA

7d•Remote

About The Position

Under general supervision, and in collaboration with other members of the clinical team, this role authorizes and reviews the utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. The Care Manager collects and analyzes utilization data, assists with discharge planning and care coordination, and provides member assistance with mental health and substance abuse issues. They also participate in special quality improvement projects. The role involves monitoring inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. Responsibilities include telephone triage, crisis intervention, emergency authorizations, and performing concurrent reviews for various levels of care. In conjunction with providers and facilities, the Care Manager develops and oversees the implementation of discharge plans. They perform quality clinical reviews, educate, and make appropriate interventions to advance the care of the member in treatment. Additionally, the role provides information to members and providers regarding benefits, community treatment resources, managed care programs, and company policies. Interaction with Physician Advisors for clinical and authorization discussions, participation in quality improvement activities, and maintaining an active workload according to performance standards are key. The role also involves working with community agencies, proposing alternative treatment plans when requests do not meet medical necessity criteria, and participating in network development. Advocating for the patient to ensure treatment needs are met and interacting with providers professionally and respectfully are also crucial aspects of this position. The job duties listed are representative and may be supplemented by additional duties assigned by a leader.

Requirements

Current, active Louisiana license is required.
Candidates must be licensed in Louisiana.
One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN.
Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
Strong organization, time management and communication skills.
Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
Knowledge and experience in inpatient and/or outpatient setting.
Knowledge of DSM V or most current diagnostic edition.

Nice To Haves

Clinical Work Experience - Preferred

Responsibilities

Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings.
Collects and analyzes utilization data.
Assists with discharge planning and care coordination.
Provides member assistance with mental health and substance abuse issues.
Participates in special quality improvement projects.
Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
Provides telephone triage, crisis intervention and emergency authorizations as assigned.
Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
In conjunction with providers and facilities, develops discharge plans and oversees their implementation.
Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
Participates in quality improvement activities, including data collection, tracking, and analysis.
Maintains an active work load in accordance with National Care Manager performance standards.
Works with community agencies as appropriate.
Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
Participates in network development including identification and recruitment of quality providers as needed.
Advocates for the patient to ensure treatment needs are met.
Interacts with providers in a professional, respectful manner that facilitates the treatment process.