UM Care Manager - Prior Authorization (evenings, nights, weekends) in Remote at Beacon Health Options

Date Posted: 9/13/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Care Manager to join our Prior Authorization Team (PAT)! The Prior Authorization Clinician is an integral part of the clinical team who performs telephonic pre-admission reviews for mental health and substance use services for inpatient and diversionary care settings, for all Beacon national contracts and lines of business.

*This position is for nights, weekends, and holidays*

Position Responsibilities:

  • Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon’s medical necessity criteria
  • Pre authorizes treatment for medical necessity for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
  • Provides telephone triage and crisis intervention to callers.
  • Logs into ACD system for phone coverage of the clinical queue, in a call center environment
  • Interacts with Physician Advisors to discuss clinical/authorization questions and concerns regarding specific cases
  • Interacts with providers, crisis teams and facilities in a professional, respectful manner that facilitates the pre authorization process
  • Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria
  • Complies with Beacon’s standards for documentation of clinical information, clinical contacts and authorization of care
  • Complies with regulatory standards and turn-around times
  • Maintains standard of departments productivity levels
  • Assists with NCQA, URAC and other QI initiatives
  • Other duties as assigned       

Position Requirements:

  • Education: Master’s Degree or higher in a health related field
  • Licensure: Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) is required and incumbent must practice within the scope of license
  • Relevant Work Experience: 2 years of combined direct behavioral health clinical and managed care experience is required
  • Knowledge, Skills, & Abilities: Must be educated in current principles and procedures of behavior health care as well as state specific expertise and knowledge of community resources

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