The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health and substance use disorder inpatient and outpatient benefits through telephonic and written processes. Also provides telephonic support for crisis intervention, assessment and short-term problem resolution and referral to appropriate provider(s).
Location: Remote/work at home.
How you will make an impact:
Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.
Refers cases to Peer Reviewers as appropriate.
Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.
Minimum Requirements:
Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure is required.
Licensure is a requirement for this position.
However, for states that do not require licensure a Board-Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.
Preferred Skills, Capabilities, and Experiences:
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
Availability to work weekends and some Holidays in a rotation.
