Behavioral Health Care Manager / 13-4132 at Medford

Position Description:

To provide behavioral health case management and utilization review in order to ensure timely and appropriate level of care of the membership while in BH acute care, diversionary, or ambulatory levels of care and coordination of care.  To facilitate coordination and integration of behavioral health, medical management, and social case management.

RESPONSIBILITIES:

To ensure that Network Health members receive timely response to requests and concurrent reviews for behavioral health services and to ensure appropriate level of care of the membership while in acute care, diversionary, or ambulatory levels of care. 

Conduct precertification and concurrent reviews of acute/postacute facility LOS and coordinate discharge plans for step-down and ambulatory levels of care and available community resources.

Coordinate the delivery of services to members throughout the continuum of care and interface with appropriate providers to meet these services.

Interact with department identifying variances to care coordination and specific payment and level of care situations.

Identify through Proactive concurrent reviews high-risk/high cost complex members for appropriate  program case management.

Perform case management interventions for the identified population, as appropriate.

Hand-off to disease/program specific diagnosis to appropriate case manager for program admission as appropriate.

Coordinate care with medical and social case management.

Communicate effectively with Associate Medical Director regarding identified variances or specific members according to criteria utilized for appropriate level of care.

Provide clinical coverage for the clinical access line and maintain standards for responsiveness.

Identify opportunities for improvement and develops action plans when necessary.

OTHER JOB FUNCTIONS:

Conduct extended care reviews for ambulatory BH services.

Interface with state agencies including DMA, DSS, and DMH to facilitate appropriate care.

Collaborate with BH Specialists around clinical network management issues.

Participate in task forces and other committees.

All other related duties as assigned.

Qualifications:

Education:

• RN, Masters in Nursing or Social Work or Doctorate in Psychology

Skills/Experience:

• Two years experience in Concurrent Review/Utilization management in behavioral health acute care or managed care.
• Two years direct clinical experience. Solid understanding of different levels of care in behavioral health.
• Medicaid experience a plus.Computer experience.
• Familiarity with decision support systems for level of care criteria a plus.
• Excellent interpersonal, communication, and planning skills.
• Team player.
• Certificate/License: RN, LICSW,LMHC, Clinical Nurse Specialist, or Licensed Psychologist

Country: USA, State: Massachusetts, City: Medford, Company: Network Health.