Behavioral Health Care Manager I managing psychiatric and substance abuse treatment through telephonic or written review. Ensuring access to quality behavioral healthcare under UM Clinical Guidelines and contract standards.
Responsibilities
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
Requirements
Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing
Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
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 in applicable states or territory of the United States required
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
Experience in behavioral health utilization management is highly preferred
Exceptional at multitasking in a fast-paced environment is preferred
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams) is preferred
Strong typing accuracy skills are highly preferred
Good communication and organization skills are preferred
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred
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