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CARE MANAGER-CRL in Remote at Beacon Health Options

Date Posted: 1/11/2019

Job Snapshot

Job Description



About the Position:

We are currently seeking a Care Manager to join our Central Referral Line team based in the Morrisville, NC area or this role can be based remote.

Individual can be based remotely for this role.

Position Responsibilities:

Triage Assessment and Referral Responsibilities:

  • 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 need
  • Give referral and/or make referral appointment as circumstances warrant
  • 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

Clinical Review Responsibilities:

  • Review for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply Beacon Health Options criteria
  • 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 / Administrative Responsibilities:

  • 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
  • Will facilitate all tracking necessary quality indicators to meet the necessary accrediting bodies (NCQA, URAC)
  • Perform special projects and all other duties as assigned

Position Minimum Requirements:

  • Education: Minimum of a master’s degree in mental health related discipline or a minimum of an associate’s degree in nursing with related psychiatric nursing experience.
  • Licensures: Not Required
  • Relevant Work Experience: 3 years’ experience in psychiatric or substance use treatment required
    • Experience as a CEAP or EAP internal/external consultant to a work site area required (for the integrated unit)
    • Experience in settings that include inpatient, partial, and/or outpatient care preferred
  • Knowledge, Skills, & Abilities:
    • 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

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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