Case Manager - Utilization Management

Maine Health•Portland, ME

30d•Remote

About The Position

The Case Manager - Behavioral HealthCare Program (BHCP) is a part of MaineHealth's ACO and this role provides mental health and substance abuse management services to members in ambulatory, inpatient, crisis, stabilization unit, outpatient and alternative care settings. This role ensures that patients receive quality clinical care and authorizes necessary services in appropriate and cost-effective settings. Prior utilization management experience is required. This benefit eligible part-time position offers a few different scheduling options that we are happy to discuss during the interview process. Mondays will be required and Fridays are preferred. The Behavioral HealthCare Program (BHCP) manages the mental health and substance use benefits for 165,000 members of several health insurance plans in Maine, New Hampshire, Vermont, New York and Pennsylvania. BHCP helps members access the most appropriate provider and level of care to meet their needs. BHCP is committed to quality service through local coordination and strong provider involvement. Our partners include: Aetna/MaineHealth, US Family Health Plan at Martin's Point, Martin's Point Generations Advantage and Anthem/MaineHealth Medicare Advantage. With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.

Requirements

Maine state licensure to practice as a Licensed Clinical Social Worker (LCSW), Licensed Clinical Professional Counselor (LCPC), Registered Nurse - Certified Nursing Specialist (RNCS), Advanced Registered Nurse Practitioner (ARNP) is required
RNCS, ARNP, LCSW, LCPC or PhD Degree required.
Current applicable state(s) license in area of education required.
Prior utilization management experience is required.

Nice To Haves

Three years (postgraduate) of clinical experience preferred.

Responsibilities

provides mental health and substance abuse management services to members in ambulatory, inpatient, crisis, stabilization unit, outpatient and alternative care settings
ensures that patients receive quality clinical care
authorizes necessary services in appropriate and cost-effective settings