Care Manager

Maryland Heights, MO 63043

Posted: 01/14/2019 Category: Registered Nurse Job Number: 23713
Description:
  • 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.
  • n 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.
Education:
  • Master’ s degree.
  • Missouri license as a professional counselor or clinical social work.
Skills:
  • Must have strong time management skills and organizational skills.
  • Be able to type and talk at the same time- Strong typing skills.
  • Strong MS Office, computer skills.
  • Be able to multi-task.
  • Clinical training must include instruction on chemical dependency, mental health and brief therapy.
  • Must have understanding of workplace issues, how businesses function and a fundamental understanding of employee/employer relationships. Must be capable of acquiring an understanding of EEO rules, ADA in the workplace, FMLA, and Drug Free Workplace Requirements.
  • Must be able to provide accurate client assessment including level of risk, substance abuse and dependency, job performance issues and refer to appropriate level of care.
  • Competent in crisis intervention.
  • Demonstrates knowledge and expertise in solution-focused, brief therapy in outpatient setting. Strong customer service skills required. Must be able to sensitively, compassionately respond to callers.
  • Excellent listening skills vital. Interacts effectively at all levels both within the company and with external customers.
  • Analyzes and presents issues in a clear, concise, persuasive manner, both orally and in writing. Uses time to manage caseload and documentation effectively. Meets productivity targets and quality management expectations.
  • Develops effective working relationships with peers within and across organizational lines.
  • Effectively resolves individual conflicts.
  • Supports department mission and keeps management informed of team issues.
  • Takes responsibility for own development and stays current on skills and techniques needed to perform job.
  • Able to adjust well to new situations and changing priorities.
  • Deals well with ambiguity and stress while handling a variety of assignments.
  • Maintains a positive, achievement-oriented attitude and consistent in accomplishing expected objectives.
  • Clinical training must include instruction on chemical dependency, mental health and brief therapy.
  • Must have understanding of workplace issues, how businesses function and a fundamental understanding of employee/employer relationships. 
For more information, please contact our office at 877-782-3334.
 

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