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Date Added: Fri 24/07/2020

Behavioral Health UM Care Manager (Part

Tampa, Florida, US
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Company: CENTENE

Job Type: Permanent, PartTime

Behavioral Health UM Care Manager (Part-Time)

Position Purpose: Provides behavioral health care management services through prospective, concurrent and retrospective evaluation and review of treatment. Determines medical necessity, level of care required and quality of care provided. Coordinates and manages behavioral health services rendered by network and non-network providers to health plan members using InterQual criteria, clinical skills and expertise, persuasive communication and access to care standards to promote cost-effective quality outcomes. Oversees and coordinates all facets of care management including initial contacts, necessary triage, pre-certification, administrative and clinical concurrent review, discharge and aftercare planning/referrals and linkage of patients to appropriate mental health providers and outside agencies for follow-up care. Candidate Education: Required A Bachelor's Degree in nursing (if RN)

Essential Functions: * Performs behavioral health triage and crisis management services. Links and coordinates services with medical/surgical departments and other outside agencies, such as transportation and home health care. Coordinates psychiatric diagnoses, behavioral health treatment services, and psychotropic medications with behavioral health providers and physician advisors. Refers members to the appropriate level care and reviews and authorizes care services using InterQual criteria and medical necessity guidelines. Documents treatment authorizations and monitors, tracks and reports behavioral health care utilization.
* Conducts all necessary direct utilization management activities for behavioral health plan members including service coordination for members in crisis, crisis intervention, behavioral health triage, crisis assessment services, pre-certification and authorization of care for both psychiatric and chemical dependency services, all necessary concurrent review with hospitals and mental health centers, discharge and aftercare planning and referrals for continued outpatient care.
* Interacts on a daily basis with hospital representatives and attending psychiatrists and coordinates physician-to-physician reviews with the medical director. Reviews treatment plans and consults with medical director regarding medical necessity criteria for continued inpatient stay. Facilitates community placements, agency linkages and coordinates discharge planning, aftercare, referral and follow-up of inpatients.
* Documents, monitors, tracks, and reports authorizations, denials, treatment plans, clinical findings, progress notes, and case dispositions related to behavioral health services using automated and manual systems and formats.
* Monitors, tracks and reports cases. Monitors utilization trends by hospital and attending psychiatrist with emphasis on managing high volume providers.
* Identifies high risk/high volume members for more intensive follow-up care and conducts hand-off coordination between Clinical Coordinators and providers.
* Coordinates community resources with emphasis on the development of natural support system. Coordinates benefits, regulations, laws and public entitlement programs. Applies psychological and counseling theory and industry standard clinical guidelines with the appropriate ICD-9/DSM IV diagnosis. Maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding abuse and neglect.
* Ensures members have access, availability and quality care according to standards.
* Participates in case conferences regarding high risk/high volume regarding provider and hospital issues. Attends and participates in other HBH work groups and meetings as required.
* Responds to incoming telephone calls as assigned, meeting or exceeding the standards for phone access and availability in order to meet the needs of members served by the department.
* Performs all other clinical and administrative duties as assigned.

This position is part-time (20 hours)

Required or equivalent work experience (if RN) beyond 2+ years
Required A Master's Degree in clinical social work, psychology, counseling, rehabilitation etc. (if LSCW)Candidate Experience: Required 2+ years of experience in using clinical criteria to determine level of treatment. Examples: Interqual, MCG/Millimen, ASAM, etc.
Required 1+ year of experience in clinical behavioral health experience providing direct patient care services
Preferred Other Experience providing care management or utilization management services in a managed behavioral health organization, community mental health center, health plan or hospital
Required Other Knowledgeable of and comply with state and federal statutes, rules and policies that affect the members Licenses and Certifications:A license in one of the following is required: Required Other One of the following licenses is required
Required Licensed Registered Nurse (RN)
Required Licensed Clinical Social Worker (LCSW)
Required Licensed Clinical Marriage & Family Therapist (LCMFT)
Required Licensed Clinical Mental Health Counselor (LCMHC)
Required Licensed Professional Counselor (LPC)
Required Licensed Psychologist
Required Licensed Marital and Family Therapist (LMFT)
Required Licensed Mental Health Counselor (LMHC)

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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