The BH Care Manager (UM) job progression is primarily a provider facing role although it does involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
Primary duties may include, but are not limited to:
- 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.
- Overview of role: In-patient reviews. Caseload would be 8-12 cases (clinical decisions) per day
- Requires MS or MA in social work, counseling, nursing or a related behavioral health field required.
- 3 years experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment required.
- Current active unrestricted license as an RN, LCSW, LMSW, LMHC, LPC, LBA, 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.
- Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.