CARE MANAGER-CRL in Roseland, NJ at Beacon Health Options

Date Posted: 9/21/2018

Job Snapshot

Job Description

About The Position:

The Clinical Care Manager provides assessments, referrals and counseling and conducts telephone assessments by collecting sufficient clinical information to make appropriate referral and certification decisions for emergency/urgent referrals that require alternate levels of care. They will collaborate with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. He/she will refer cases to MD, or management on a regular basis to determine whether treatment meets Beacon Health Options criteria for medical necessity. He/ she will facilitate coordination of care with other managers to assure continuity of care and evaluate clinical appropriateness of treatment using professional knowledge within Beacon Health Options clinical and work site guidelines. He/she will render certification decisions, or seeks consultations for non-certification decisions and will facilitate all tracking necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC). The Clinical Care Manager will also direct members to an appropriate therapist or EAP provider and refer cases to MD, or management on a regular basis to determine whether treatment meets Beacon Health Options criteria for medical necessity. They will establish and deliver knowledge about care resources and levels of care availability. Special projects and all other duties as assigned.

Position 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 and 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 and adhere to the components of the Compliance Program.
    •  Ensure that job tasks are performed in a legal and ethical manner and 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.

Position Requirements:

  • Education: Masters’ degree in social work or psychology or a Bachelor’s level RN.
  • Licenses: 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 is required. 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 is required (For the integrated unit). Must possess the ability to function in an interdisciplinary setting and must have knowledge and experience using management information systems. Strong customer service orientation and excellent written and verbal communication skills are required. He/she must be knowledgeable about care resources and levels of care availability.

To Apply:

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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