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Role Description

As a Behavioral Health Utilization Care Manager, you will be assigned to various hospitals where you will authorize initial admitting and do concurrent reviews for medical necessity. You will be working with facilities and out-patient providers and will collaborate with other reviewers if there is a change to patients' continuum of care. You will utilize your clinical experience, excellent collaboration skills, strong time management, and your ability to be a strong communicator to meet requirements for compliancy and member care.

Your work schedule will be Monday-Friday primarily 8:00 a.m.- 5:00 p.m. Arizona Time Zone. Your work location will be entirely remote. This position does require Arizona residency for compliance.

This position is the point person for all utilization activities for assigned members. As part of an interdisciplinary team, this position:

• Reviews and authorizes behavioral health and substance abuse services in inpatient, residential, and outpatient settings using approved medical necessity criteria.
• Monitors care to ensure treatment is appropriate and effective.
• Assesses the member’s plan of care and develops, implements, monitors, and documents the utilization of resources and progress of the member through their care.
• Facilitates options and services to meet the member’s health care needs.
• Provides telephonic or electronic document review.
• Engages internal and external resources to ensure members receive appropriate care plan and discharge planning services.
• Monitors for quality of care concerns.
• Staffs regularly with medical directors.
• Provides education and recommends alternative care plans for treatment not meeting medical necessity criteria.
• Is accountable for the quality of clinical services delivered by both them and others.
• Identifies/resolves barriers which may hinder effective care delivery to members.
• May conduct prior authorization, concurrent, retrospective, and appeal reviews.

Qualifications

• Master’s degree in social work, counseling, or related field or with independent or associate licensure.
• Licensure in at least one of the following categories as required by state law: Social work, professional counseling, or marriage and family.
• Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist.
• Proficiency level typically achieved with three years clinical experience (i.e. counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
• Working knowledge of care management, case management, hospital, and community resources.
• Demonstrated critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
• Ability to work effectively independently and in an interdisciplinary team format.

Requirements

• Previous experience with behavioral health utilization management preferred.
• Additional related education and/or experience preferred.

Benefits

• Comprehensive benefits package.
• Opportunities for personal and professional growth.
• Inclusive and empowering work environments.
• Resources that promote a healthy work-life balance.