University of Pittsburgh Medical Center-posted 4 months ago
$27 - $46/Yr
Full-time
Remote • Pittsburgh, PA
Hospitals

UPMC Community Care Behavioral Health is hiring a full-time Precert Care Manager. This role will work 4 ten-hour overnight shifts, Thursday - Sunday 9:30 pm - 8 am. This role works fully remote and must reside within 2 hours of a CCBH office location. Candidate should reside within Pennsylvania or the tri-state area. A Precert Care Manager for the 24 hour precert team must be able and willing to work daylight, evening, and night shift positions that also rotate weekend and holiday coverage. A Precert Care Manager is responsible for documenting and reviewing clinical information and making authorization determinations for adult and child/adolescent members being referred to acute and non-ambulatory mental health and substance use disorder levels of care for all Community Care contracts. The Care Manager will also be responsible for crisis management and referring members to appropriate services based on triage assessment. The Care Manager executes these responsibilities consistent with the applicable Community Care Policies and Procedures. A care manager represents the organization to providers, member groups and families, and participates in the overall administration of clinical operations as warranted. A care manager is expected to bring a level of clinical leadership to the care management department. In addition, a care manager may serve as the care management lead for other members of his/her team.

  • Assumes responsibility for completion of acute and non-ambulatory precerts and application of appropriate medical necessity guidelines.
  • Assist with moving members to in network facilities or coordinating with appropriate Community Care contracts regarding approval for out of network service utilization.
  • Consults with appropriate physician advisors as needed for case collaboration and care planning.
  • Develops specific clinical interventions and coordinates with the assigned Community Care contract and care management team for members who do not maintain regular contact with their behavioral health provider.
  • Participates in professional development activities to further clinical skills and knowledge.
  • Demonstrates advanced level of computer operation with electronic medical record systems and Microsoft Outlook, Word, and Excel Programs.
  • Receives and responds appropriately to complex calls, including Afterhours/Weekend Employee Assistance Program calls, triage calls, and provider or member complaints.
  • Coordinates, reviews, and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports.
  • Independently problem solves based on advanced-level knowledge of the service delivery system, clinical treatment, diversion resources, and the provider network.
  • Responds to deadlines and has work completed on or before deadline 95% of the time.
  • Identify need for and facilitate linkages for members and families between primary care and behavioral health providers and other social service or provider agencies.
  • Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures.
  • Demonstrates excellent clinical, written and oral communication skills.
  • Utilizes supervision with team coordinator and clinical manager regularly.
  • A current and unrestricted Pennsylvania Licensure in health or human services field (LSW, LCSW, LPC, LMFT) and master's degree OR licensed RN.
  • Minimum of three years of relevant clinical experience.
  • Experience with both adult and child/adolescent populations and mental health and substance use disorder services strongly preferred.
  • Experience in managed care strongly preferred.
  • General knowledge of best practices in behavioral health, emphasizing work with special needs or priority populations and in public sector systems.
  • Certification in substance use disorders helpful.
  • DSM-5 TR, ASAM, and Confidentiality Training preferred.
  • Salary Range: $27.08-46.81 USD
  • Full-Time position
  • Remote work option
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