Care Manager - BH - Hollidaysburg, PA

Military Spouse Corporate Career Network • Hollidaysburg, PA

6d • Onsite

About The Position

Under general supervision and in collaboration with other members of the clinical team, the Care Manager authorizes and reviews the utilization of mental health and substance abuse services in inpatient and/or outpatient care settings. The role collects and analyzes utilization data, assists with discharge planning and care coordination, supports members with mental health and substance abuse concerns, and participates in quality improvement projects.

The Care Manager monitors levels of care to assess medical necessity and effectiveness; performs concurrent reviews and, when assigned, telephone triage, crisis intervention, and emergency authorizations. In conjunction with providers and facilities, the Care Manager develops discharge plans and oversees their implementation. The role conducts quality clinical reviews, educates and intervenes to advance member care, and provides members and providers with information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria. The Care Manager consults Physician Advisors about clinical and authorization questions, works with community agencies, proposes alternative treatment plans when requests do not meet medical necessity criteria, and may participate in provider network development. The role advocates for patients and maintains professional, respectful provider interactions.

This is a full-time, onsite position at the Blair County OMH office in Hollidaysburg, Pennsylvania, working Monday through Friday. It is not available for remote work. Duties listed are representative rather than exhaustive; additional duties aligned with the role may be assigned.

Requirements

• Current licensure meeting state, commonwealth, or customer-specific requirements.
• One or more of the following licenses or certifications, with the necessary degree: CEAP, LMSW, LCSW, LSW, LPC, or RN.
• 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 of 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: Associate degree in Nursing, Bachelor's degree in Social Work, or Master's degree in Social Work.

Responsibilities

• Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient settings.
• Collect and analyze utilization data.
• Assist with discharge planning and care coordination.
• Provide member assistance related to mental health and substance abuse issues.
• 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 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.
• Conduct quality clinical reviews and provide education and 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 about clinical and authorization questions and concerns regarding 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.
• 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