Care Manager

Job Title: Clinical Services Group - Care Manager - BH

Job Location: 100% Remote San Diego CA (Must reside in California)

Job Duration: 9 Months possible extension

Job 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.
• 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.

RESPONSIBILITIES:

• Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
• One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LPC, RN or LPN.
• Minimum 2 years’ experience post degree in healthcare, behavioural health, psychiatric and/or substance abuse health care setting. Strong organization, time management and communication skills.
• 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.

WORK EXPERIENCE:

Clinical 2 years

Certifications:

Must have one of the following:

• Must be Independently licensed in State of California.
• CEAP - Certified Employee Assistance Professional,
• LCSW - Licensed Clinical Social Worker,
• LMFT - Licensed Marriage and Family Therapist,
• LMSW - Licensed Master Social Worker,
• LPC - Licensed Professional Counsellor,
• LPN - Licensed Practical Nurse,
• RN - Registered Nurse, State and/or Compact State Licensure

EDUCATION:

Dependent on Certification

Associates: Nursing,

Bachelors: Social Work,

Masters: Social Work (Required)

DN01

Job Type: Contract

Salary: $30.00 - $40.00 per hour

Expected hours: 40 per week

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Associate (Required)

Location:

• California (Required)

Work Location: Remote