Care Manager BH
3131 Camino Del Rio North San Diego, CA 92108
Looking for a licensed professional to work as a Care Manager. 100% Telephonic job! Must be willing to work out of San Diego office.
Care Manager Job Description Summary
- Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data.
- Assists with discharge planning and care coordination.
- Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
- Monitors inpatient and/or outpatient 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.
- Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
- In conjunction with providers and facilities, develops discharge plans and oversee their implementation.
- Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
- 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 and authorization questions and concerns regarding specific cases.
- Participates in quality improvement activities, including data collection, tracking, and analysis.
- Maintains an active work load in accordance with National Care Manager performance standards.
- Works with community agencies as appropriate.
- Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
- Participates in network development including identification and recruitment of quality providers as needed.
- Advocates for the patient to ensure treatment needs are met.
- Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Degree: Masters Degree
- CA license with one or more of the following licensure is required for this role with necessary degrees: LCSW, LPC, or LMFT.(LCMFT - Licensed Clinical Marriage and Family Therapist - Care Mgmt LCSW - Licensed Clinical Social Worker - Care Mgmt LPC - Licensed Professional Counselor - Care Mgmt)
- Strong organization, time management and communication skills.
- Must be computer savvy with the ability to multi-task and type with high accuracy (min 35wpm) - candidates must take a typing test prior and average WPM must be listed at top of resume in the summary.
- Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
- Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
- Knowledge and experience in inpatient and/or outpatient setting.
- Knowledge of DSM V or most current diagnostic edition.
- Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care .
- 2 weeks classroom training, then 2-6 weeks of side by side training and shadowing (dependent on aptitude of candidate)
877-782-3334, EXT 246