Date Posted: 9/5/2018

Job Snapshot

Job Description


We are currently seeking a dynamic CLINICAL CARE MANAGER to join our Utilization Management team at our office in Newark, NJ.  The CLINICAL CARE MANAGER performs utilization review and initial authorization determination of mental health and substance use services provided in inpatient, diversionary and outpatient care settings.  S/he applies Beacon’s medical necessity level of care criteria and ensures that all Beacon policy and procedure guidelines, external regulatory requirements and URAC/NCQA accreditation standards are met.   

Position Responsibilities:

  • Performs telephonic case review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance treatment facilities as assigned
  • Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria
  • Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria
  • Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
  • Provides information to members and providers regarding mental health and substance abuse benefits and community treatment resources
  • Identifies and refers high-risk members to case management.
  • Recognizes quality of care issues and reports them appropriately through internal and external processes.
  • Interacts with providers and facilities in a professional, respectful manner
  • Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
  • Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
  • Assists with NCQA, URAC and other QI initiatives
  • Other duties as assigned.

Position Requirements:

Educaion: A minimum of a B.S. Degree in mental health field or an Associate’s Degree in Nursing with related psychiatric nursing experience.

Licensure:  Current valid and unrestricted license in a state or territory of the United States in a mental health field (RN, Ph.D, LMSW/LCSW, MHC, LLP, LPC, etc.) License in NJ

Relevant Work Experience:  3 – 5 years of direct practice experience in settings that include inpatient, partial, and/or outpatient preferred.

Knowledge, Skills & Abilities:

  • Strong organizational skills
  • Knowledge of Word and Excel
  • Excellent communication skills (verbal and in writing) are required
  • Ability to manage multiple priorities and work collaboratively within a team environment required.

Potential work from home opportunity following in office training.


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

Beacon Health Options company 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