Care Manager (UM/UR) - Remote - Coeur d'Alene, ID
About The Position
Under general supervision, and in collaboration with other members of the clinical team, this role authorizes and reviews 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. This position also participates in special quality improvement projects. The Care Manager monitors 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, and emergency authorizations as assigned. The role 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, the Care Manager develops discharge plans and oversees their implementation. The position performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment. The Care Manager 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. The role interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases. The Care Manager participates in quality improvement activities, including data collection, tracking, and analysis. The position maintains an active work load in accordance with National Care Manager performance standards and works with community agencies as appropriate. The role proposes alternative plans of treatment when requests for services do not meet medical necessity criteria and participates in network development including identification and recruitment of quality providers as needed. The Care Manager advocates for the patient to ensure treatment needs are met and interacts with providers in a professional, respectful manner that facilitates the treatment process. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Requirements
- Requires Idaho licensure.
- If residing outside of Idaho, must also be licensed in the State of residence.
- Must have the required skill set, education requirements, and experience.
Nice To Haves
- This is a remote position.
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.
- Develops discharge plans and oversees their implementation in conjunction with providers and facilities.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
