CARE MANAGER in Remote at Beacon Health Options

Date Posted: 2/22/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Outpatient Utilization Review Clinician to join our team at our office in Miami, Florida.  The Utilization Review Clinician will be responsible for performing utilization review and/or initial authorization determination of mental health and substance use services provided in outpatient and/or diversionary care settings.  The incumbent applies medical necessity level of care criteria and ensures that all policy and procedure guidelines, external regulatory requirements and URAC/NCQA accreditation standards are met.   

Position Responsibilities:

  • Provide initial treatment plan clinical reviews, concurrent treatment plan reviews, case consultations and determine level care based on medical necessity
  • Coordinating outpatient discharge planning with the practitioner to assure continuity of care
  • Assist members and providers who call to understand treatment options and available services, as well as explanation of benefits
  • Verify member coverage and advise all parties involved of the implications for treatment
  • Provide input into the development of case management systems

Position Requirements:

Education: Master’s degree or higher in a health related field or BSN

Licensure:  Must be a licensed behavioral health clinician and practice within the scope of their licensure with a minimum of 2 years behavioral health experience.

Relevant Work Experience:   Experience with managed care preferred

Knowledge, Skills & Abilities:

  • Moderate skill level in MS Office environment (Outlook, Word, Excel, PowerPoint)
  • Team player with an ability to work under pressure
  • Ability to remain objective in all dealings with customers and maintain professional attitude at all times

TO APPLY

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

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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