UM Care Manager - Northeast Region in Remote at Beacon Health Options

Date Posted: 9/5/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Care Manager to join our Utilization Management team! The UM 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.  

*This a remote / work at home position for applicants who are licensed in the state of Massachusetts*

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:

  • Education: Master’s degree in social work, psychology, mental health, nursing, or other related field required

  • Licensure:  Current, valid, unrestricted clinical license in Massachusetts (incl. LMHC, LICSW, LMFT, RN, PhD.) required in the state of Massachusetts

  • Relevant Work Experience: 1 year post-licensure clinical experience providing direct care.

  • Knowledge, Skills & Abilities:

    • Critical thinking skills and ability to work independently

    • Computer and typing skills necessary

    • Must be able to work one weekend shift per month

    • Potential work from home opportunity after in office training

To Apply:

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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