• Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings • Collects and analyzes utilization data • Assists with discharge planning and care coordination • Provides member assistance with mental health and substance abuse issues • Participates in special quality improvement projects • Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness • Provides telephone triage, crisis intervention and emergency authorizations as assigned • Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience • Develops discharge plans and oversees their implementation • Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment • Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures • Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases • Participates in quality improvement activities, including data collection, tracking, and analysis • Maintains an active workload in accordance with National Care Manager performance standards • Works with community agencies as appropriate • Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria • Participates in network development including identification and recruitment of quality providers as needed • Advocates for the patient to ensure treatment needs are met