Behavioral Health Care Manager

Bethlehem, PA

Post Date: 06/27/2017 Job ID: 22150 Category: Registered Nurse

Shift:
  • 8: 30am 5pm

Training:
  • About 1 week classroom training and then hands-on/peer training.

Job Description:
  • Under general supervision, and in collaboration with other members of the clinical team, the selected candidate will authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings.
  • Caseload: 20 calls/day

Responsibilities:
  • Collects and analyzes utilization data.
  • Assists with discharge planning and ambulatory follow up activity.
  • Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
  • Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
  • Provides telephone triage, crisis intervention and emergency authorizations as assigned.
  • In conjunction with providers and facilities, develops discharge plans and oversee their implementation.
  • Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience.
  • Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
  • Interacts with Physician Advisors to discuss Clinical/authorization questions and concerns regarding specific cases.
  • Participates in quality improvement activities, including data collection, tracking, and analysis. Works with community agencies as appropriate.
  • Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
  • Advocates for the patient to ensure treatment needs are met.
  • Interacts with providers in a professional, respectful manner that facilitates the treatment process.

Requirements/Certifications:
  • License: LCPC, LCSW, LSW or RN.
  • The manager is looking for candidates who have at least 1 year of Managed Care exp AND Drug & Alcohol experience.
  • She is also looking for someone with community resource experience.

Qualifications:
  • Candidate must be comfortable with working in a cubicle environment.
  • Comfortable with typing and talking at the same time, comfortable working in a fast pace environment, and comfortable navigating through multiple systems.
  • MUST be computer literate.

A-Line Staffing Solutions

877-782-3334

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