CARE MANAGER-CNS in Latham, NY at Beacon Health Options

Date Posted: 6/28/2018

Job Snapshot

Job Description

General Summary: Provides assessments, referrals and counseling. Conducts telephone

assessments, collecting sufficient clinical information to make appropriate referral and

certification decision for emergency/urgent referrals that require alternate levels of care. Makes

appropriate certification decisions. Collaborates with providers to determine alternate levels of

care and to facilitate transfers to network facilities and providers whenever possible. Facilitates

coordination of care with other managers to assure continuity of care. Evaluates clinical

appropriateness of treatment using professional knowledge within Beacon Health Options clinical and work site guidelines. Will render certification decisions, or seeks consultations for non-certification

decisions. Will facilitate all tracking necessary quality indicators to meet these necessary

accrediting bodies (NCQA, URAC). Directs members to an appropriate therapist or EAP provider. Clinical Care Manager refers cases to MD, or management on a regular basis to determine whether treatment meets Beacon Health Options criteria for medical necessity. Establishes and delivers knowledge about care resources and levels of care availability. Special projects and all other duties as assigned.

Essential Duties and Responsibilities:

Triage Assessment and Referral

Complete telephone assessments and referral; gathers demographic and clinical information to connect

patient with appropriate provider, including outpatient treatment as necessary; and for emergency,

urgent, routine and EAP referrals. Provide appropriate referrals for treatment based in assessment of

information gathered during telephone contacts and or on-site with providers. Refer cases that do not

meet criteria and need non-cert., to Peer Advisors. Manage release of MHSA benefit provided by carrier

for designated group. Ask questions and listen to member in order to assess case and determine needs.

Give referral and/or make referral appointment as circumstances warrant.

Clinical Reviews

Review for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to

apply Beacon Health Options criteria and render certification decisions that are within the scope of practice that is relevant to the clinical area under review. Provide reviews for predetermination of medical necessity. Review proposed courses of treatment for medical necessity. Utilize rounds and case consultations to Clinical Supervisor and Peer Advisor for cases outside criteria or not progressing.

Customer Service

Interface with internal and external customers to maintain optimal efficiency of service. Maintain

telephone superior service standards. Contribute to monthly staff meetings and clinical conferences.

Attend appropriate meetings, trainings and conference calls as scheduled. Perform all other aspects of

customer service as required. Conduct business in a professional manner. Troubleshoot Clinical issues.

Investigate and research to resolve customer complaint problems and issues.

Professional Standards

Apply Beacon Health Options policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity and performance standards. Support Beacon Health Options in achieving Mission Statement. Complete tasks accurately and within required timeframes. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment.

Minimum Entry Level Qualifications: Must possess the ability to function in an interdisciplinary setting. Must have knowledge and experience using management information systems. Strong customer

service orientation and excellent written and verbal communication skills required. Must be knowledgeable about care resources and levels of care availability.

  • Education: Masters’ degree in social work or psychology or a Bachelor’s level RN. 
  • Licensures: Appropriately licensed healthcare professionals to manage Utilization Management. Must have a current, valid and unrestricted license in a State or territory of the United States in a mental health field (RN, Ph.D., LCSW/ACSW/LMSW, LLP, MHC, LPC, etc.).  May be required to obtain additional state licensures dependent on client contractual requirements.
  • Relevant Work Experience: A minimum of 3 years’ experience in psychiatric or substance use treatment. Experience in settings that include inpatient, partial, and/or outpatient care preferred. Experience as a CEAP or EAP internal/external consultant to a work site area required (for the integrated unit.

  • Supervise Staff?                YES              NO

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